Provider Demographics
NPI:1053069948
Name:HERINK, SHELLINA MARIE
Entity Type:Individual
Prefix:
First Name:SHELLINA
Middle Name:MARIE
Last Name:HERINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 HIGHWAY E29
Mailing Address - Street 2:
Mailing Address - City:CLUTIER
Mailing Address - State:IA
Mailing Address - Zip Code:52217-9540
Mailing Address - Country:US
Mailing Address - Phone:319-330-0689
Mailing Address - Fax:
Practice Address - Street 1:1307 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IA
Practice Address - Zip Code:52342-2307
Practice Address - Country:US
Practice Address - Phone:641-484-5253
Practice Address - Fax:641-484-5312
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist