Provider Demographics
NPI:1396030581
Name:SHELTON, MEGAN (PT)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:LEANN SHELTON
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:355 RIDGE RUN TRL
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8667
Mailing Address - Country:US
Mailing Address - Phone:803-271-2364
Mailing Address - Fax:803-708-5618
Practice Address - Street 1:355 RIDGE RUN TRL
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8667
Practice Address - Country:US
Practice Address - Phone:803-271-2364
Practice Address - Fax:803-708-5618
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist