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General NPI Number Information
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NPI Number | 1699104919
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Entity Type | Individual
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Provider Name | SHANNON FEUTZ
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Gender | Female
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 8301 E PRENTICE AVE SUITE 207
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2903
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Country | US
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Telephone | 303-322-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 209 WRIGHT ST APT 208
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City | LAKEWOOD
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State | CO
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Zip | 80228-1405
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Country | US
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Telephone | 906-202-0846
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0012443
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License Number State | CO
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