Provider Demographics
NPI:1639736374
Name:SHELTON MOVEMENT AND PERFORMANCE
Entity type:Organization
Organization Name:SHELTON MOVEMENT AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:336-933-1544
Mailing Address - Street 1:163 STRATFORD CT STE 135
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1830
Mailing Address - Country:US
Mailing Address - Phone:336-933-1544
Mailing Address - Fax:
Practice Address - Street 1:163 STRATFORD CT STE 135
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1830
Practice Address - Country:US
Practice Address - Phone:336-933-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy