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General NPI Number Information
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NPI Number | 1376658732
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Entity Type | Individual
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Provider Name | SHANNON S. BERG CMT
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1931 BOISE AVE SUITE 1
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City | LOVELAND
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State | CO
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Zip | 80538-4295
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Country | US
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Telephone | 719-510-4233
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Fax | 970-663-4524
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Provider Business Mailing Address
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Address Line | 1931 BOISE AVE SUITE 1
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City | LOVELAND
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State | CO
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Zip | 80538-4295
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Country | US
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Telephone | 719-510-4233
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Fax | 970-663-4524
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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 |
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License Number State |
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