Provider Demographics
NPI:1548012701
Name:FRALEY, SHELLY LYNN
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:FRALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WINDING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:MI
Mailing Address - Zip Code:48367-3946
Mailing Address - Country:US
Mailing Address - Phone:586-864-6107
Mailing Address - Fax:
Practice Address - Street 1:873 W AVON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2705
Practice Address - Country:US
Practice Address - Phone:248-656-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002033225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant