Provider Demographics
NPI:1598399180
Name:REGESTER, SHELLEY MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:MARIE
Last Name:REGESTER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35511 SLEEPY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-9514
Mailing Address - Country:US
Mailing Address - Phone:909-380-4745
Mailing Address - Fax:
Practice Address - Street 1:35511 SLEEPY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-9514
Practice Address - Country:US
Practice Address - Phone:909-380-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist