Healthcare Provider Details

I. General information

NPI: 1871580969
Provider Name (Legal Business Name): MEDICAL REHABILITATION ASSOCIATES, INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6086 AUBURN CT
BURLINGTON KY
41005-8022
US

IV. Provider business mailing address

1964 HOWELL BRANCH RD STE 108
WINTER PARK FL
32792-1042
US

V. Phone/Fax

Practice location:
  • Phone: 304-809-5312
  • Fax: 410-250-7756
Mailing address:
  • Phone: 407-681-2241
  • Fax: 407-279-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: CARL RANDOLPH SHELTON
Title or Position: PRESIDENT
Credential: MD
Phone: 304-809-5312