Provider Demographics
NPI:1043199433
Name:GILBERT, SHELLY RENE (PTA)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:RENE
Last Name:GILBERT
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 1:4805 CR 306B
Mailing Address - Street 2:
Mailing Address - City:LAKE PANASOFFKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33538-3335
Mailing Address - Country:US
Mailing Address - Phone:352-457-6000
Mailing Address - Fax:
Practice Address - Street 1:413 N WEST ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-6021
Practice Address - Country:US
Practice Address - Phone:352-569-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25410225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant