Provider Demographics
NPI:1891008058
Name:FUCHS, SHELLY MARIE (LPTA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:FUCHS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W BURLEIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2410
Mailing Address - Country:US
Mailing Address - Phone:352-253-2340
Mailing Address - Fax:352-253-2346
Practice Address - Street 1:322 W BURLEIGH BLVD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2410
Practice Address - Country:US
Practice Address - Phone:352-253-2340
Practice Address - Fax:352-253-2346
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA13849225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant