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Individual

JESSICA M. SHELTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT, MSPT

Contact information

Practice address
2106 EXECUTIVE DR, HAMPTON, VA 23666-2402
(757) 838-6678
(757) 838-8116
Mailing address
240 W SENECA ST STE 12, MANLIUS, NY 13104-2422
(315) 682-0325
(315) 682-0323

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207576
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1447507306
VA
01
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
08/10/2012
Last updated
05/20/2021
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