Provider Demographics
NPI:1740951169
Name:HUFFAKER, SHELBY LEIGH (PTA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LEIGH
Last Name:HUFFAKER
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 1:10251 RIDGELINE DR APT A318
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2349
Mailing Address - Country:US
Mailing Address - Phone:509-741-0052
Mailing Address - Fax:
Practice Address - Street 1:524 N ELY ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2576
Practice Address - Country:US
Practice Address - Phone:509-783-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP161037800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant