Provider Demographics
NPI:1962109751
Name:SHANLEY PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:SHANLEY PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSEBROCK-SHANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:530-448-6033
Mailing Address - Street 1:1560 GRAND POINT WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2521
Mailing Address - Country:US
Mailing Address - Phone:530-448-6033
Mailing Address - Fax:
Practice Address - Street 1:1560 GRAND POINT WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2521
Practice Address - Country:US
Practice Address - Phone:530-448-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy