Provider Demographics
NPI:1437836772
Name:SHELTON, LEANNE
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 OLD FRANKLIN TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:GLADE HILL
Mailing Address - State:VA
Mailing Address - Zip Code:24092
Mailing Address - Country:US
Mailing Address - Phone:276-340-5647
Mailing Address - Fax:
Practice Address - Street 1:3837 BRANDON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1441
Practice Address - Country:US
Practice Address - Phone:540-776-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant