Provider Demographics
NPI:1730808494
Name:CLARK, SHELBY LAYNE (DPT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LAYNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:L
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:11100 HIGHWAY 165 STE 5
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-9781
Practice Address - Country:US
Practice Address - Phone:501-945-0200
Practice Address - Fax:501-945-0245
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13677612251P0200X, 225100000X
ARPT5170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1367761OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
ARPT5170OtherARKANSAS DEPARTMENT OF HEALTH STATE BOARD OF PHYSICAL THERAPY