Provider Demographics
NPI:1902117294
Name:THOMAS SHIPLEY, KYLIE L (PT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:L
Last Name:THOMAS SHIPLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:308-382-3241
Practice Address - Street 1:5000 N 26TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4749
Practice Address - Country:US
Practice Address - Phone:402-742-8410
Practice Address - Fax:402-742-8411
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist