Provider Demographics
NPI:1205888740
Name:KOEHLER, SHELLY ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:ANN
Last Name:KOEHLER
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 1:211 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4616
Mailing Address - Country:US
Mailing Address - Phone:308-633-2025
Mailing Address - Fax:308-633-2029
Practice Address - Street 1:211 W 38TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4616
Practice Address - Country:US
Practice Address - Phone:308-633-2025
Practice Address - Fax:308-633-2029
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025780200Medicaid
NENA1402007Medicare PIN