Provider Demographics
NPI:1003463233
Name:SHELTON, SCOTT PATRICK (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PATRICK
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 22ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3022
Mailing Address - Country:US
Mailing Address - Phone:808-218-4802
Mailing Address - Fax:
Practice Address - Street 1:111 BETHEL ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4365
Practice Address - Country:US
Practice Address - Phone:360-596-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA609769552081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3738549OtherPERSONAL