Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1137644 | TX |
NPI | 1043513872 |
---|---|
Provider Name | Mrs. Rachelle Lea Shelton |
First Address | Keller, TX 76248-3876 |
Second Address | Keller, TX 76248-3876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2010 |
Last Update Date | 16/09/2021 |