Provider Demographics
NPI:1831588672
Name:URKOSKI, SHELLY
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:URKOSKI
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 1:102 E MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS
Mailing Address - State:NE
Mailing Address - Zip Code:68628-2881
Mailing Address - Country:US
Mailing Address - Phone:402-469-9107
Mailing Address - Fax:
Practice Address - Street 1:102 E MORRIS ST
Practice Address - Street 2:
Practice Address - City:CLARKS
Practice Address - State:NE
Practice Address - Zip Code:68628-2881
Practice Address - Country:US
Practice Address - Phone:402-469-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4852255A2300X
NE944225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty