Healthcare Provider Details

I. General information

NPI: 1710060918
Provider Name (Legal Business Name): SHELLEY SULLIVAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 HARRISON AVE
BUTTE MT
59701-4801
US

IV. Provider business mailing address

1309 HARRISON AVE
BUTTE MT
59701-4801
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-5887
  • Fax: 406-782-8772
Mailing address:
  • Phone: 406-782-5887
  • Fax: 406-782-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number786PT
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number786PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: