Provider Demographics
NPI:1245561760
Name:MCMURRAY, SHELLI DEAN (PTA)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:DEAN
Last Name:MCMURRAY
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 1:1913 E CESAR CHAVEZ ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4501
Mailing Address - Country:US
Mailing Address - Phone:541-580-6590
Mailing Address - Fax:
Practice Address - Street 1:1913 E CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4501
Practice Address - Country:US
Practice Address - Phone:541-580-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60048751225200000X
OR8270225200000X
FLPTA 21241225200000X
TX2102529225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant