Provider Demographics
NPI:1629058722
Name:SEIFERT, SHELLEY DAWN (PT)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:DAWN
Last Name:SEIFERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N LOUISE ST
Mailing Address - Street 2:#8
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1612
Mailing Address - Country:US
Mailing Address - Phone:818-484-5026
Mailing Address - Fax:
Practice Address - Street 1:1130 N LOUISE ST
Practice Address - Street 2:#8
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1612
Practice Address - Country:US
Practice Address - Phone:818-484-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1074225100000X
CAPT14468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI225615OtherHMSA
HI235416Medicare ID - Type Unspecified
52913Medicare ID - Type Unspecified