Provider Demographics
NPI:1396975728
Name:SILAS, SHELBY I (PTA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:I
Last Name:SILAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GAINSBOROUGH ST APT 206
Mailing Address - Street 2:25 MONSON ST. BROCKTON MA 02301
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-4238
Mailing Address - Country:US
Mailing Address - Phone:774-259-6718
Mailing Address - Fax:
Practice Address - Street 1:30 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4938
Practice Address - Country:US
Practice Address - Phone:617-734-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant