Provider Demographics
NPI:1043513872
Name:SHELTON, RACHELLE LEA (PT)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:LEA
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:RACHELLE
Other - Middle Name:LEA
Other - Last Name:RICHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1652 KELLER PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3876
Mailing Address - Country:US
Mailing Address - Phone:817-562-3111
Mailing Address - Fax:817-562-3114
Practice Address - Street 1:1652 KELLER PARKWAY
Practice Address - Street 2:STE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3876
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:817-562-3114
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11376442251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics