Healthcare Provider Details

I. General information

NPI: 1811209430
Provider Name (Legal Business Name): RT2G
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 OXFORD LN
FORT COLLINS CO
80525-2243
US

IV. Provider business mailing address

749 OXFORD LN
FORT COLLINS CO
80525-2243
US

V. Phone/Fax

Practice location:
  • Phone: 970-775-0382
  • Fax:
Mailing address:
  • Phone: 970-775-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number1388
License Number StateCO

VIII. Authorized Official

Name: ANGELA MICHELLE SHOCKLEY
Title or Position: OWNER
Credential: CRTT
Phone: 970-775-0382