Provider Demographics
NPI:1639725088
Name:NIEBRUGGE, SHELBY ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN
Last Name:NIEBRUGGE
Suffix:
Gender:F
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 1:1014 N KOESTER DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1745
Mailing Address - Country:US
Mailing Address - Phone:217-821-7558
Mailing Address - Fax:
Practice Address - Street 1:1004 HEALTH CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4607
Practice Address - Country:US
Practice Address - Phone:217-258-2530
Practice Address - Fax:217-258-4176
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.026569225100000X
MO2019030032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist