Healthcare Provider Details

I. General information

NPI: 1710968128
Provider Name (Legal Business Name): SHELTON THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SAINT JOHNS BLUFF RD N STE 1
JACKSONVILLE FL
32225-6704
US

IV. Provider business mailing address

720 SAINT JOHNS BLUFF RD N STE 1
JACKSONVILLE FL
32225-6704
US

V. Phone/Fax

Practice location:
  • Phone: 904-646-1144
  • Fax: 904-928-0039
Mailing address:
  • Phone: 904-646-1144
  • Fax: 904-928-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA J DAVIS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 904-646-1144