Healthcare Provider Details

I. General information

NPI: 1073243747
Provider Name (Legal Business Name): SHELBY CUFFLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SHADWELL AVE
FLORA IL
62839-2310
US

IV. Provider business mailing address

103 W EDGEWOOD AVE
EFFINGHAM IL
62401-2973
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-8361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160008985
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: