Provider Demographics
NPI:1922843390
Name:STINGLEY, SHELBY ROSE (PTA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ROSE
Last Name:STINGLEY
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 1:129 CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1801
Mailing Address - Country:US
Mailing Address - Phone:319-777-8278
Mailing Address - Fax:
Practice Address - Street 1:129 CRESCENT CT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1801
Practice Address - Country:US
Practice Address - Phone:319-777-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32380225200000X
IACP028114A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant