Provider Demographics
NPI:1992998827
Name:SHELTON, JUSTIN (PT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E SONTERRA BLVD
Mailing Address - Street 2:STE# 410
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3971
Mailing Address - Country:US
Mailing Address - Phone:210-403-2098
Mailing Address - Fax:210-403-2167
Practice Address - Street 1:300 E SONTERRA BLVD
Practice Address - Street 2:STE# 410
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3971
Practice Address - Country:US
Practice Address - Phone:210-403-2098
Practice Address - Fax:210-403-2167
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist