MEDICARE: JUSTIN SHELTON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1176108	TX

General Provider Information

NPI Number	:	1992998827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN SHELTON PT

Provider Business Mailing Address
First Line	:	300 E SONTERRA BLVD
Second Line	:	STE# 410
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3971
Country	:	US
Telephone Number	:	210-403-2098
Fax Number	:	210-403-2167

Provider Business Practice Location Address
First Line	:	300 E SONTERRA BLVD
Second Line	:	STE# 410
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3971
Country	:	US
Telephone Number	:	210-403-2098
Fax Number	:	210-403-2167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	09/28/2011

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Directions to “ JUSTIN SHELTON PT” Practice Location

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