Basic Information
| Provider Information | |||||||||
| NPI: | 1730284068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANAHAN | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | MATHESON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOTCHKISS | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | MATHESON | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.S.P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6979 S HOLLY CIR | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801121577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036942295 | ||||||||
| FaxNumber: | 3036941843 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 S ALLISON PKWY | ||||||||
| Address2: | STE 305 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802263129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032377715 | ||||||||
| FaxNumber: | 3032371157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 03/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 7520 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 102255323 | 01 | OWCP FACILITY ID | OTHER |