Healthcare Provider Details

I. General information

NPI: 1902117294
Provider Name (Legal Business Name): KYLIE L THOMAS SHIPLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 N 26TH ST SUITE 400
LINCOLN NE
68521-4749
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-8410
  • Fax: 402-742-8411
Mailing address:
  • Phone: 308-382-0344
  • Fax: 308-382-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2893
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: