Provider Demographics
NPI:1881039618
Name:DIRKS, SHAYLEE (PTA)
Entity Type:Individual
Prefix:
First Name:SHAYLEE
Middle Name:
Last Name:DIRKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7950
Mailing Address - Country:US
Mailing Address - Phone:402-332-3773
Mailing Address - Fax:
Practice Address - Street 1:720 N HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7950
Practice Address - Country:US
Practice Address - Phone:402-332-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1179225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant