Individual
MARCI SHELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 TROWBRIDGE RD, NEOGA, IL 62447-1121
(217) 343-1505
Mailing address
15392 E 700TH AVE, WATSON, IL 62473-2314
(217) 343-1505
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160004451
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160004451
PHYSICAL THERAPY LICENSE
IL
Enumeration date
05/04/2021
Last updated
05/04/2021
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