Healthcare Provider Details

I. General information

NPI: 1659680379
Provider Name (Legal Business Name): CASSANDRA LEE SHAWCROSS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11409 BUSINESS PARK CIR STE 200
FIRESTONE CO
80504-9203
US

IV. Provider business mailing address

1805 104TH AVENUE CT
GREELEY CO
80634-4825
US

V. Phone/Fax

Practice location:
  • Phone: 720-727-1141
  • Fax:
Mailing address:
  • Phone: 303-349-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.0012213
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: