Healthcare Provider Details

I. General information

NPI: 1770111965
Provider Name (Legal Business Name): SHELBY BABCOCK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 E LAMAR BLVD STE 600
ARLINGTON TX
76011-4127
US

IV. Provider business mailing address

1800 MAIN ST APT 1056
DALLAS TX
75201-5220
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-6789
  • Fax:
Mailing address:
  • Phone: 816-262-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1305247
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: