Basic Information
| Provider Information | |||||||||
| NPI: | 1649334087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINE | ||||||||
| FirstName: | SHELLEY | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 JEFFERSON TRL | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762058285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404831108 | ||||||||
| FaxNumber: | 9404831108 | ||||||||
| Practice Location | |||||||||
| Address1: | 2535 WEST OAK STREET | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762012311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403821577 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1136455 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 1136455 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | P00950353 | 01 | TX | RAILROAD MEDICARE | OTHER | 854T77 | 01 | TX | BCBS ORTHOTEXAS | OTHER |