Provider Demographics
NPI:1871148163
Name:SHELTON-DESPAIN, ERIN ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELIZABETH
Last Name:SHELTON-DESPAIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:SHELTON-DESPAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:154 KINTER WAY STE A
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-2218
Mailing Address - Country:US
Mailing Address - Phone:540-921-5200
Mailing Address - Fax:540-921-5100
Practice Address - Street 1:154 KINTER WAY STE A
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-2218
Practice Address - Country:US
Practice Address - Phone:540-921-5200
Practice Address - Fax:540-921-5100
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist