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General NPI Number Information
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NPI Number | 1255561486
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Entity Type | Organization
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Legal Business Name | SHARED SUMMIT HEALTH LLC
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 2362 EAGLEVIEW CIR
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City | LONGMONT
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State | CO
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Zip | 80504-7797
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Country | US
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Telephone | 303-774-9155
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Fax | 303-997-1811
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Provider Business Mailing Address
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Address Line | 2362 EAGLEVIEW CIR
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City | LONGMONT
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State | CO
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Zip | 80504-7797
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Country | US
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Telephone | 303-774-9155
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Fax | 303-997-1811
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Authorized Official
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Title or Position | OWNER / OPERATOR
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Name | MS. GAIL SUZANNE LONGENECKER
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Credential | DIP LCM
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Telephone | 303-774-9155
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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 | 3184
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License Number State | CO
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