Provider Demographics
NPI:1215390547
Name:MARTIN, SHELBY N (MS, ATC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 G B HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7587
Mailing Address - Country:US
Mailing Address - Phone:704-254-3312
Mailing Address - Fax:
Practice Address - Street 1:1700 DOGWOOD MILE ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5521
Practice Address - Country:US
Practice Address - Phone:704-254-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-33122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer