Provider Demographics
NPI:1891845061
Name:SHELTON, LISA SPEAKMAN (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SPEAKMAN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:SPEAKMAN
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32 WINDWARD DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2174
Mailing Address - Country:US
Mailing Address - Phone:540-949-5383
Mailing Address - Fax:540-949-5493
Practice Address - Street 1:32 WINDWARD DR
Practice Address - Street 2:SUITE 110
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2174
Practice Address - Country:US
Practice Address - Phone:540-949-5383
Practice Address - Fax:540-949-5493
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305005713OtherLICENSE#