Provider Demographics
NPI:1992914048
Name:WEST, SHELLY S (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:S
Last Name:WEST
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:S
Other - Last Name:PRECHTL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3774 WELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685
Mailing Address - Country:US
Mailing Address - Phone:727-772-7444
Mailing Address - Fax:727-785-7329
Practice Address - Street 1:3774 WELLINGTON PKWY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685
Practice Address - Country:US
Practice Address - Phone:727-772-7444
Practice Address - Fax:727-785-7329
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 17201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0541Medicare ID - Type Unspecified