Provider Demographics
NPI:1962485656
Name:SHELTON, DAVID AARON (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:AARON
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 1:720 SAINT JOHNS BLUFF RD N
Mailing Address - Street 2:
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:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2803OtherBCBS
FLY2803ZMedicare ID - Type Unspecified