Healthcare Provider Details

I. General information

NPI: 1376954925
Provider Name (Legal Business Name): SHELLI ANN VICARS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N 30TH ST OUTPATIENT THERAPIES
BILLINGS MT
59101-0127
US

IV. Provider business mailing address

1233 N 30TH ST OUTPATIENT THERAPIES
BILLINGS MT
59101-0127
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-6400
  • Fax:
Mailing address:
  • Phone: 406-238-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2329
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: