Provider Demographics
NPI:1932624632
Name:HASSEBROCK-SHANLEY, LAUREL PATRICIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:PATRICIA
Last Name:HASSEBROCK-SHANLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:PATRICIA
Other - Last Name:SHANLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3030 LEADERSHIP PKWY UNIT 8312
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1495 RIDGEVIEW DR STE 120
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-6315
Practice Address - Country:US
Practice Address - Phone:775-323-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3575261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy