=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306146758
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET MARIE JAMES SHELTON LMT, MLD-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2010
-----------------------------------------------------
Last Update Date | 12/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4875 PALM COAST PKWY NW UNIT 2-3
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32137-3670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-838-0699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94 BUTTONWORTH DR # B
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32137-9403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-838-0699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA96693
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------