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General NPI Number Information
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NPI Number | 1053944017
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Entity Type | Individual
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Provider Name | SHELBY RANDOLPH DPT
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Gender | Female
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 3600 LINCOLN WAY
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City | AMES
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State | IA
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Zip | 50014-7595
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Country | US
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Telephone | 515-663-4824
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 DUFF AVE
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City | AMES
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State | IA
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Zip | 50010-5469
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Country | US
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Telephone | 515-239-4400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4263
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 096285
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License Number State | IA
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