Healthcare Provider Details

I. General information

NPI: 1265558449
Provider Name (Legal Business Name): CLAIRE MICHELE SHELTON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N EMERALD LN SUITE 1A
CARBONDALE IL
62901-2100
US

IV. Provider business mailing address

8812 OLD HIGHWAY 13
MURPHYSBORO IL
62966-5586
US

V. Phone/Fax

Practice location:
  • Phone: 618-549-9449
  • Fax:
Mailing address:
  • Phone: 618-684-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: