Provider Demographics
NPI:1417589201
Name:SHELBY, MCKENZIE PAIGE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:PAIGE
Last Name:SHELBY
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MEMORIAL DR APT 317
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1174
Mailing Address - Country:US
Mailing Address - Phone:847-873-7941
Mailing Address - Fax:
Practice Address - Street 1:2900 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-5000
Practice Address - Country:US
Practice Address - Phone:218-281-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer