Provider Demographics
NPI:1760747166
Name:KING, SHELLEY DAWN
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:DAWN
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:DAWN
Other - Last Name:MONCIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:97 THORNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006-5128
Mailing Address - Country:US
Mailing Address - Phone:731-660-2171
Mailing Address - Fax:731-660-2171
Practice Address - Street 1:250 N PARKWAY
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2735
Practice Address - Country:US
Practice Address - Phone:731-668-1372
Practice Address - Fax:731-664-9919
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant