Provider Demographics
NPI:1619774858
Name:DEGENER, SHELBIE LARUE (LMT)
Entity type:Individual
Prefix:MS
First Name:SHELBIE
Middle Name:LARUE
Last Name:DEGENER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 DOLPHIN PT APT 614
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2166
Mailing Address - Country:US
Mailing Address - Phone:262-880-5721
Mailing Address - Fax:
Practice Address - Street 1:255 DOLPHIN PT APT 614
Practice Address - Street 2:
Practice Address - City:CLEARWATER BEACH
Practice Address - State:FL
Practice Address - Zip Code:33767-2166
Practice Address - Country:US
Practice Address - Phone:262-880-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-97331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist