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General NPI Number Information
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NPI Number | 1003539644
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Entity Type | Individual
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Provider Name | SHAUN ENGLISH WEAKLEY LMT
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Gender | Male
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 108 W 5TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-3118
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Country | US
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Telephone | 719-621-8374
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Fax |
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Provider Business Mailing Address
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Address Line | 108 W 5TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-3118
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Country | US
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Telephone | 719-621-8374
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT.0018186
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License Number State | CO
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