Provider Demographics
NPI:1548038458
Name:SHIPLEY, COURTNI (PTA)
Entity type:Individual
Prefix:
First Name:COURTNI
Middle Name:
Last Name:SHIPLEY
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 1:112 S REYMANN ST
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1730
Mailing Address - Country:US
Mailing Address - Phone:304-725-3632
Mailing Address - Fax:
Practice Address - Street 1:112 S REYMANN ST
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1730
Practice Address - Country:US
Practice Address - Phone:304-725-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604261225200000X
WV002409225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant