MEDICARE: SHELLEY LYNN GILLIS P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1233870

General Provider Information

NPI Number	:	1124450770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY LYNN GILLIS P.T.

Provider Business Mailing Address
First Line	:	920 HILLCREST DR
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-3196
Country	:	US
Telephone Number	:	940-553-2877
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 HILLCREST DR
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-3196
Country	:	US
Telephone Number	:	940-553-2877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	05/06/2026

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