Provider Demographics
NPI:1053164152
Name:PRATT, SHELBY (MT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 HILL AVE LOT 92
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-4710
Mailing Address - Country:US
Mailing Address - Phone:419-245-8353
Mailing Address - Fax:
Practice Address - Street 1:3601 HILL AVE LOT 92
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-4710
Practice Address - Country:US
Practice Address - Phone:419-245-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025733225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist