Provider Demographics
NPI:1932474855
Name:ELDER, SHAYLA K (PT)
Entity Type:Individual
Prefix:MS
First Name:SHAYLA
Middle Name:K
Last Name:ELDER
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 1:230 N PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3934
Mailing Address - Country:US
Mailing Address - Phone:316-685-2603
Mailing Address - Fax:
Practice Address - Street 1:230 N PERSHING ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3934
Practice Address - Country:US
Practice Address - Phone:316-685-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01987225100000X
CO4431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist