Provider Demographics
NPI:1710968128
Name:SHELTON THERAPY INC
Entity Type:Organization
Organization Name:SHELTON THERAPY INC
Other - Org Name:PROGRESSIVE STEP REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-646-1144
Mailing Address - Street 1:720 SAINT JOHNS BLUFF RD N
Mailing Address - Street 2:STE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6704
Mailing Address - Country:US
Mailing Address - Phone:904-646-1144
Mailing Address - Fax:904-928-0039
Practice Address - Street 1:720 SAINT JOHNS BLUFF RD N
Practice Address - Street 2:STE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6704
Practice Address - Country:US
Practice Address - Phone:904-646-1144
Practice Address - Fax:904-928-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK5020OtherRAILROAD MEDICARE
FLY907ROtherBCBS
FLCK5020OtherRAILROAD MEDICARE