Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT00003763 | WA |
NPI | 1083950455 |
---|---|
Provider Name | Lalani Shelton |
First Address | Olympia, WA 98512 |
Second Address | Tumwater, WA 98512-6912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2012 |
Last Update Date | 12/12/2012 |