Basic Information
| Provider Information | |||||||||
| NPI: | 1518277169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOOK | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MRS. | ||||||||
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| OtherLastName: | SHOOK | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | H | ||||||||
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| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 0362 COUNTY RD 165 | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81623 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1378 WEST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709636600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 10/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PT-6840 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.