Individual provider · Type 1 NPI

Shane David Nibley

Rehabilitation Practitioner · South Lake Tahoe, CA

NPI number 1255200846 Active

Practice location

3079 Harrison Ave
South Lake Tahoe, CA 96150-7976

Call (530) 957-6254 Map

Mailing address

406 Sunrise Ave Ste 300
Roseville, CA 95661-4144

Specialties and licenses

TaxonomyCodeLicense
Case Manager/Care Coordinator 171M00000XNone listed
Rehabilitation Practitioner Primary 225400000XNone listed
Day Training/Habilitation Specialist 373H00000XNone listed

Rehabilitation Practitioner: A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.

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About NPI 1255200846

Shane David Nibley's National Provider Identifier is 1255200846, issued on Nov 1, 2025. The primary taxonomy on file is Rehabilitation Practitioner (225400000X), and the practice location is in South Lake Tahoe, CA. The record was last updated on Dec 11, 2025.