Healthcare Provider Details

I. General information

NPI: 1407533250
Provider Name (Legal Business Name): SHELBY M DAVIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E 23RD AVE
HUTCHINSON KS
67502-1106
US

IV. Provider business mailing address

200 ANDERSON
ANDALE KS
67001-7003
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07369
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: