Provider Demographics
NPI:1932178498
Name:SHELTON, CATHERINE MARIE (MAPT)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-0220
Mailing Address - Country:US
Mailing Address - Phone:843-251-2767
Mailing Address - Fax:803-932-9618
Practice Address - Street 1:4871 SOCASTEE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7252
Practice Address - Country:US
Practice Address - Phone:843-293-5610
Practice Address - Fax:843-293-5690
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3715Medicaid
SCGP3715Medicaid
SCQ33283Medicare UPIN