Provider Demographics
NPI:1649389370
Name:SHELTON, KORY BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:BROOKE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 W SEVILLA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8716
Mailing Address - Country:US
Mailing Address - Phone:804-304-8640
Mailing Address - Fax:
Practice Address - Street 1:3606 W SEVILLA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8716
Practice Address - Country:US
Practice Address - Phone:804-304-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT22092OtherLICENSE #