Healthcare Provider Details

I. General information

NPI: 1639501059
Provider Name (Legal Business Name): SHANDLI BLAINE JOYCE PT, DPT, ATC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 VANN RD
NEWBURGH IN
47630-7447
US

IV. Provider business mailing address

4711 VANN RD
NEWBURGH IN
47630-7447
US

V. Phone/Fax

Practice location:
  • Phone: 812-760-1344
  • Fax:
Mailing address:
  • Phone: 812-760-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT21103924
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011220A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001922A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: