Provider Demographics
NPI:1558733691
Name:HAMPTON, SHELLY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 ELTON HILLS DR NW
Mailing Address - Street 2:APT 25
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-4905
Mailing Address - Country:US
Mailing Address - Phone:608-778-3382
Mailing Address - Fax:
Practice Address - Street 1:358 ELTON HILLS DR NW
Practice Address - Street 2:APT 25
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4905
Practice Address - Country:US
Practice Address - Phone:608-778-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist