Provider Demographics
NPI:1083882526
Name:MEJIA, SHELLEY LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNN
Last Name:MEJIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:LYNN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:29650 BRADLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6521
Mailing Address - Country:US
Mailing Address - Phone:951-672-0455
Mailing Address - Fax:951-672-0206
Practice Address - Street 1:29650 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-6521
Practice Address - Country:US
Practice Address - Phone:951-672-0455
Practice Address - Fax:951-672-0206
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist