Healthcare Provider Details

I. General information

NPI: 1154041143
Provider Name (Legal Business Name): SHELBY KLINE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S DOUGLAS HWY STE 120
GILLETTE WY
82716-4949
US

IV. Provider business mailing address

1211 S DOUGLAS HWY STE 120
GILLETTE WY
82716-4949
US

V. Phone/Fax

Practice location:
  • Phone: 307-670-8111
  • Fax: 307-670-8113
Mailing address:
  • Phone: 307-670-8111
  • Fax: 307-670-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2193
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: