Healthcare Provider Details

I. General information

NPI: 1841527827
Provider Name (Legal Business Name): SHELLEY CELESTE D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W RENO AVE STE F
LAS VEGAS NV
89118-1609
US

IV. Provider business mailing address

3555 W RENO AVE STE F
LAS VEGAS NV
89118-1609
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-0037
  • Fax: 702-262-0252
Mailing address:
  • Phone: 702-262-0037
  • Fax: 702-262-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2363
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: