Healthcare Provider Details

I. General information

NPI: 1932396991
Provider Name (Legal Business Name): SHELLI RENEE STEVENSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 GRAND AVENUE STE 203
BILLINGS MT
59102
US

IV. Provider business mailing address

3307 GRAND AVENUE STE 203
BILLINGS MT
59102
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-9060
  • Fax: 406-655-9065
Mailing address:
  • Phone: 406-655-9060
  • Fax: 406-655-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number33974
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2284PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: