Provider Demographics
NPI:1265546980
Name:SHELTON, THOMAS JAMES (PT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAMES
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:121 BISHOP STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701
Mailing Address - Country:US
Mailing Address - Phone:606-528-5122
Mailing Address - Fax:606-528-5127
Practice Address - Street 1:121 BISHOP STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701
Practice Address - Country:US
Practice Address - Phone:606-528-5122
Practice Address - Fax:606-528-5127
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist