Provider Demographics
NPI:1407113509
Name:BRANCH, SHELLEY LYNN (CPTA)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LYNN
Last Name:BRANCH
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERBROOK
Mailing Address - State:KS
Mailing Address - Zip Code:66524-9496
Mailing Address - Country:US
Mailing Address - Phone:785-665-7124
Mailing Address - Fax:
Practice Address - Street 1:700 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OVERBROOK
Practice Address - State:KS
Practice Address - Zip Code:66524-9496
Practice Address - Country:US
Practice Address - Phone:785-665-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00275225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant