Provider Demographics
NPI:1023855970
Name:DAVIS, SHELBY LOUISE (DPT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 RIVERFRONT WAY
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-7313
Mailing Address - Country:US
Mailing Address - Phone:541-228-4570
Mailing Address - Fax:541-689-4525
Practice Address - Street 1:4660 MAIN ST STE 6-100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6087
Practice Address - Country:US
Practice Address - Phone:541-683-6187
Practice Address - Fax:541-689-4525
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist