Individual
SHELLY LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9108 LAGUNA MAIN ST STE 1A, ELK GROVE, CA 95758-7450
(916) 421-4117
Mailing address
8205 ORELLI CT, SACRAMENTO, CA 95828-7562
(916) 230-7797
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
34220
CA
Other
Enumeration date
03/06/2017
Last updated
08/19/2019
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