Provider Demographics
NPI:1063626588
Name:TIMMONS, SHELLEY RAE (DPT)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:RAE
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2446
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-2446
Mailing Address - Country:US
Mailing Address - Phone:340-244-2558
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:213 ESTATE SMITHFIELD
Practice Address - Street 2:
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840
Practice Address - Country:US
Practice Address - Phone:340-244-2558
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI249261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI249OtherPHYSICAL THERAPY LICENSE
CA23001OtherPHYSICAL THERAPY LICENSE