Healthcare Provider Details

I. General information

NPI: 1033832159
Provider Name (Legal Business Name): BILLI-JO SHIRLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32246 CLINTON KEITH RD STE 103
WILDOMAR CA
92595-7320
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 951-677-7221
  • Fax: 951-677-7331
Mailing address:
  • Phone: 951-335-9825
  • Fax: 951-666-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: