Individual
MARY KRISTEN SHIPLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
Mailing address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11480
NC
2251X0800X
Orthopedic Physical Therapist
Primary
11480
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790963155
—
NC
01
—
Q36607A
MEDICARE PTAN
NC
01
—
Q36607B
MEDICARE
NC
Enumeration date
02/07/2008
Last updated
07/10/2024
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