Provider Demographics
NPI:1841850716
Name:FAGAN ABREU, SHELBY LEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LEE
Last Name:FAGAN ABREU
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 1:10730 NALL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1285
Mailing Address - Country:US
Mailing Address - Phone:913-574-1460
Mailing Address - Fax:913-574-1496
Practice Address - Street 1:10730 NALL AVE STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1285
Practice Address - Country:US
Practice Address - Phone:913-574-1460
Practice Address - Fax:913-574-1496
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019027051225100000X
KS11-06104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist