Individual
AMY CAROL SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1250 S A W GRIMES BLVD, ROUND ROCK, TX 78664-7429
(512) 310-7665
(512) 310-9228
Mailing address
1250 S A W GRIMES BLVD, ROUND ROCK, TX 78664-7429
(512) 310-7665
(512) 310-9228
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1248996
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0331DG
BLUE CROSS BLUE SHIELD OF TEXAS
TX
05
—
094474602
—
TX
Enumeration date
08/25/2014
Last updated
08/25/2014
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