Provider Demographics
NPI:1881334134
Name:HARRISON, SHELBEY (PTA)
Entity type:Individual
Prefix:
First Name:SHELBEY
Middle Name:
Last Name:HARRISON
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 1:5402 FM 1488 RD APT 937
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3573
Mailing Address - Country:US
Mailing Address - Phone:936-499-7448
Mailing Address - Fax:
Practice Address - Street 1:750 FISH CREEK THOROUGHFARE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-6965
Practice Address - Country:US
Practice Address - Phone:936-272-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2150517225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant