| Doctor Name: | CONNIE RENEE SHELLEY |
| NPI Number: | 1902170533 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS PT |
| License Number: | 5501015742 |
| Business Practice Address: | 1147 S 3rd St Niles, MI - 491203472 |
| Business Phone Number: | 2696849470 |
| Business Fax Number: | 2696849477 |
| Mailing Address: | 2222 Sullivan Trl, EASTON |
| State: | PA |
| Postal Code: | 180407958 |
| Phone Number: | 8009449782 |
| Fax Number: | 6104382046 |
| NPI Enumeration Date: | 02/29/2012 |
| NPI Last Update Date: | 02/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501015742 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |