Healthcare Provider Details

I. General information

NPI: 1396537379
Provider Name (Legal Business Name): SHELBY SPENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY STE 200
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

5 BROADWAY PLZ
PERU IN
46970-1052
US

V. Phone/Fax

Practice location:
  • Phone: 520-462-0248
  • Fax:
Mailing address:
  • Phone: 765-327-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP059572T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: