Provider Demographics
NPI:1801207949
Name:PHILIP, SHELBY LYNN
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:PHILIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 NIDER RD
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:PA
Mailing Address - Zip Code:15542-8913
Mailing Address - Country:US
Mailing Address - Phone:814-634-9377
Mailing Address - Fax:
Practice Address - Street 1:122 NIDER RD
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:PA
Practice Address - Zip Code:15542-8913
Practice Address - Country:US
Practice Address - Phone:814-634-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer