Provider Demographics
NPI:1023446044
Name:RELLER, SHIRLEY PEARL (PT)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:PEARL
Last Name:RELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SHIRLEY
Other - Middle Name:PEARL
Other - Last Name:YEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:SCOBEY
Mailing Address - State:MT
Mailing Address - Zip Code:59263-0400
Mailing Address - Country:US
Mailing Address - Phone:406-487-2322
Mailing Address - Fax:406-487-2325
Practice Address - Street 1:105 5TH AVENUE EAST
Practice Address - Street 2:
Practice Address - City:SCOBEY
Practice Address - State:MT
Practice Address - Zip Code:59263-0400
Practice Address - Country:US
Practice Address - Phone:406-487-2322
Practice Address - Fax:406-487-2325
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-1011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist