Provider Demographics
NPI:1023133105
Name:SHELLEY, REGINA N (PT)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:N
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11564 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:NEW FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:17349-8528
Mailing Address - Country:US
Mailing Address - Phone:717-235-1958
Mailing Address - Fax:
Practice Address - Street 1:ONE TEXAS STATION CT
Practice Address - Street 2:SUITE 300
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-683-2110
Practice Address - Fax:410-683-2115
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist