Provider Demographics
NPI:1679509095
Name:SHELLEY, JULIE KLECKLEY (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KLECKLEY
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:KLECKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:734 CORLEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9426
Mailing Address - Country:US
Mailing Address - Phone:803-808-4384
Mailing Address - Fax:
Practice Address - Street 1:734 CORLEY MILL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9426
Practice Address - Country:US
Practice Address - Phone:803-808-4384
Practice Address - Fax:803-808-4384
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist