Provider Demographics
NPI:1265222384
Name:SHELLBERG, SPENCER (PT, DPT)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:SHELLBERG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LOCHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-9725
Mailing Address - Country:US
Mailing Address - Phone:517-668-5863
Mailing Address - Fax:
Practice Address - Street 1:711 LOCHWOOD CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9725
Practice Address - Country:US
Practice Address - Phone:517-668-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist