Provider Demographics
NPI:1659491694
Name:AUSTEN, SHELLEY ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:AUSTEN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 SURREY MEADOWS AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2335
Mailing Address - Country:US
Mailing Address - Phone:702-897-6856
Mailing Address - Fax:
Practice Address - Street 1:6345 S PECOS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-6222
Practice Address - Country:US
Practice Address - Phone:702-368-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV#1004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102010Medicare ID - Type Unspecified