Healthcare Provider Details

I. General information

NPI: 1730691668
Provider Name (Legal Business Name): SHANNON A SPANGLER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5988 STETSON HILLS BLVD
COLORADO SPRINGS CO
80923-3567
US

IV. Provider business mailing address

2446 RESEARCH PKWY STE 200
COLORADO SPRINGS CO
80920-1087
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-3111
  • Fax: 719-574-2912
Mailing address:
  • Phone: 719-623-1050
  • Fax: 719-623-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0015180
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: