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NPI Code Detail

MEDICARE: MRS. SHELLEY DAWN HOLLIS PT

MEDICARE: MRS. SHELLEY DAWN HOLLIS PT
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
1225100000XPhysical Therapist102032MO

General Provider Information

NPI Number : 1821025693
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHELLEY DAWN HOLLIS PT
Provider Business Mailing Address
First Line : 936 WALNUT ST
Second Line :
City : THAYER
State : MO
Zip : 65791-1251
Country : US
Telephone Number : 417-264-2286
Fax Number :
Provider Business Practice Location Address
First Line : 1480 W 8TH ST
Second Line :
City : WEST PLAINS
State : MO
Zip : 65775-2010
Country : US
Telephone Number : 417-256-5669
Fax Number : 417-256-5699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 07/09/2007

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Directions to “ MRS. SHELLEY DAWN HOLLIS PT” Practice Location

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