Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 004759 | IA |
NPI | 1003101114 |
---|---|
Provider Name | Brooke Shelquist |
First Address | Nevada, IA 50201-0461 |
Second Address | Carlisle, IA 50047-7810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 24/01/2013 |