Provider Demographics
NPI:1023227816
Name:PATRICK, SHELIA DENISE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHELIA
Middle Name:DENISE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2997 ROBBIEDON ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-4902
Mailing Address - Country:US
Mailing Address - Phone:901-337-9651
Mailing Address - Fax:901-375-9949
Practice Address - Street 1:5830 MOUNT MORIAH RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1607
Practice Address - Country:US
Practice Address - Phone:901-375-9855
Practice Address - Fax:901-375-9949
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000393225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant