MEDICARE: EMILY THERESA SHELLENBERGER DPT

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

General Provider Information

NPI Number	:	1790486728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY THERESA SHELLENBERGER DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:	517-435-3670

Provider Business Practice Location Address
First Line	:	6029 FOREST LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2703
Country	:	US
Telephone Number	:	972-979-6577
Fax Number	:	972-979-6951

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

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	10/06/2023

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