Provider Demographics
NPI:1518694280
Name:BROOKS, SHELBE DALE (LMT)
Entity Type:Individual
Prefix:
First Name:SHELBE
Middle Name:DALE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 12TH TER
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-1813
Mailing Address - Country:US
Mailing Address - Phone:918-330-6915
Mailing Address - Fax:
Practice Address - Street 1:10 TOWN SQUARE ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-7293
Practice Address - Country:US
Practice Address - Phone:918-330-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR9069OtherMASSAGE THERAPY LICENSE