Provider Demographics
NPI:1073285664
Name:SHELTON, ANNA (LMT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 JOHNSON ST SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-8505
Mailing Address - Country:US
Mailing Address - Phone:142-599-9007
Mailing Address - Fax:
Practice Address - Street 1:17416 STATE ROUTE 9 SE STE B
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-6304
Practice Address - Country:US
Practice Address - Phone:360-668-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61153153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist