Provider Demographics
NPI:1518920297
Name:BRAHLER, SHELLEY SMITH (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:SMITH
Last Name:BRAHLER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 CLIZBE AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-2935
Mailing Address - Country:US
Mailing Address - Phone:518-842-1425
Mailing Address - Fax:518-842-1706
Practice Address - Street 1:178 CLIZBE AVE
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-2935
Practice Address - Country:US
Practice Address - Phone:518-842-1425
Practice Address - Fax:518-842-1706
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0198861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02302303Medicaid
6699246OtherGHI
Q44751OtherBLUE CROSS
000491879002OtherBLUE SHIELD
10031223OtherCDPHP
43225OtherMVP
6699246OtherGHI
10031223OtherCDPHP