Provider Demographics
NPI:1689232944
Name:SHELTON, ELIZABETH JOY (LPTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOY
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:DRY FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24549-5204
Mailing Address - Country:US
Mailing Address - Phone:434-228-3774
Mailing Address - Fax:
Practice Address - Street 1:508 RISON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2457
Practice Address - Country:US
Practice Address - Phone:434-799-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604784225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2306604784Medicaid