MEDICARE: SHANNA SUZANNE STAPLETON LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist		CO

General Provider Information

NPI Number	:	1235763988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNA SUZANNE STAPLETON LMT

Provider Business Mailing Address
First Line	:	1715 15TH ST APT 2
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-6348
Country	:	US
Telephone Number	:	303-807-9973
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 IRIS AVE STE 207
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-1998
Country	:	US
Telephone Number	:	303-807-9973
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	03/02/2020

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Directions to “ SHANNA SUZANNE STAPLETON LMT” Practice Location

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