Provider Demographics
NPI:1124450770
Name:GILLIS, SHELLEY LYNN (PT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNN
Last Name:GILLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 COMMON ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3565
Mailing Address - Country:US
Mailing Address - Phone:830-625-7310
Mailing Address - Fax:
Practice Address - Street 1:1324 COMMON ST
Practice Address - Street 2:SUITE 307
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3565
Practice Address - Country:US
Practice Address - Phone:830-625-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1233870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist