Provider Demographics
NPI:1669786489
Name:BARRY, SHELLEY ROSE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ROSE
Last Name:BARRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 PIKES LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4271
Mailing Address - Country:US
Mailing Address - Phone:225-892-8928
Mailing Address - Fax:
Practice Address - Street 1:1300 LAWRENCE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT GABRIEL
Practice Address - State:LA
Practice Address - Zip Code:70776-5133
Practice Address - Country:US
Practice Address - Phone:225-892-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA7654225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant