Provider Demographics
NPI:1992971360
Name:ARMSTRONG, SHELLY LYNN (PTA)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8129 US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-9724
Mailing Address - Country:US
Mailing Address - Phone:608-332-1391
Mailing Address - Fax:
Practice Address - Street 1:1020 HILL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3016
Practice Address - Country:US
Practice Address - Phone:920-261-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI644-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant