Provider Demographics
NPI:1073746541
Name:MCCABE, SHELLEY K (DPT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:K
Last Name:MCCABE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:K
Other - Last Name:RIETMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0307
Mailing Address - Country:US
Mailing Address - Phone:801-294-6907
Mailing Address - Fax:801-294-6917
Practice Address - Street 1:130 NE THOMPSON AVENUE
Practice Address - Street 2:
Practice Address - City:HEPPNER
Practice Address - State:OR
Practice Address - Zip Code:97836
Practice Address - Country:US
Practice Address - Phone:801-294-6907
Practice Address - Fax:801-294-6917
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist