Provider Demographics
NPI:1336412543
Name:WLODARCZYK, SHELBY RENEE (MPT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:RENEE
Last Name:WLODARCZYK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 PEARL DR
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3218
Mailing Address - Country:US
Mailing Address - Phone:724-334-5852
Mailing Address - Fax:
Practice Address - Street 1:229 PEARL DR
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3218
Practice Address - Country:US
Practice Address - Phone:724-334-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010014L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist