Healthcare Provider Details

I. General information

NPI: 1487535274
Provider Name (Legal Business Name): AIDAN O'SHEA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25577 CONIFER RD UNIT 125
CONIFER CO
80433-9068
US

IV. Provider business mailing address

3216 HARTLAND RD
GASPORT NY
14067-9418
US

V. Phone/Fax

Practice location:
  • Phone: 303-838-7444
  • Fax: 720-902-6227
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15118
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: