Healthcare Provider Details

I. General information

NPI: 1992740658
Provider Name (Legal Business Name): SHELLEY KUROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11335A FOLSOM BLVD
RANCHO CORDOVA CA
95742-6224
US

IV. Provider business mailing address

1550 HARBOR BLVD SUITE 120
WEST SACRAMENTO CA
95691-3826
US

V. Phone/Fax

Practice location:
  • Phone: 916-858-0950
  • Fax: 916-858-0972
Mailing address:
  • Phone: 916-375-1667
  • Fax: 916-375-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT28591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: