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Individual

MR. JEREMIAH M SHELTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
3333 HARRISON AVE NW, SUITE 102, OLYMPIA, WA 98502-5049
(360) 292-7245
(360) 292-7247
Mailing address
PO BOX 11009, OLYMPIA, WA 98508-1009
(360) 352-2037

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00009155
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0218612
L & I
WA
01
3333SH / 1175SH
REGENCE
WA
05
8346358
WA
Enumeration date
02/19/2007
Last updated
01/10/2008
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