Provider Demographics
NPI:1376562058
Name:SHELTON, WAYNE L (PT)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:L
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 1:317 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2024
Mailing Address - Country:US
Mailing Address - Phone:801-798-9100
Mailing Address - Fax:801-798-2902
Practice Address - Street 1:317 W CENTER ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2024
Practice Address - Country:US
Practice Address - Phone:801-798-9100
Practice Address - Fax:801-798-2902
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT22-105815-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
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