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General NPI Number Information
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NPI Number | 1992740658
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Entity Type | Individual
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Provider Name | SHELLEY KUROSE
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Gender | Female
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11335A FOLSOM BLVD
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City | RANCHO CORDOVA
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State | CA
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Zip | 95742-6224
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Country | US
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Telephone | 916-858-0950
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Fax | 916-858-0972
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Provider Business Mailing Address
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Address Line | 1550 HARBOR BLVD SUITE 120
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-3826
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Country | US
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Telephone | 916-375-1667
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Fax | 916-375-1618
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT28591
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License Number State | CA
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