Provider Demographics
NPI:1801416201
Name:MERCER, SHELLEY BANKS (PT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:BANKS
Last Name:MERCER
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 1:3707 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2109
Mailing Address - Country:US
Mailing Address - Phone:318-548-4536
Mailing Address - Fax:
Practice Address - Street 1:3707 DEBORAH DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2109
Practice Address - Country:US
Practice Address - Phone:318-548-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist