Provider Demographics
NPI:1275942922
Name:SHELTON, OLIVIA (DPT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 W INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3500
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:304 W WEAVER ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510
Practice Address - Country:US
Practice Address - Phone:919-942-0240
Practice Address - Fax:919-942-0280
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist