Provider Demographics
NPI:1649334087
Name:KLINE, SHELLEY RAE (PT)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:RAE
Last Name:KLINE
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 1:2213 JEFFERSON TRL
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-8285
Mailing Address - Country:US
Mailing Address - Phone:940-483-1108
Mailing Address - Fax:940-483-1108
Practice Address - Street 1:2535 WEST OAK STREET
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2311
Practice Address - Country:US
Practice Address - Phone:940-382-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136455225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00950353OtherRAILROAD MEDICARE
TX854T77OtherBCBS ORTHOTEXAS
TXTXB118149Medicare PIN