Provider Demographics
NPI:1992311351
Name:TERRY, SHELBY BREANNE (DPT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:BREANNE
Last Name:TERRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ORCHARD PARK CT
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4872
Mailing Address - Country:US
Mailing Address - Phone:469-223-7008
Mailing Address - Fax:
Practice Address - Street 1:101 N PARKWAY DR
Practice Address - Street 2:
Practice Address - City:ALVARADO
Practice Address - State:TX
Practice Address - Zip Code:76009-3724
Practice Address - Country:US
Practice Address - Phone:817-790-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1335442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist