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NPI Code Detail

MEDICARE: MR. SHANNON ATKINSON CMT

MEDICARE: MR. SHANNON ATKINSON CMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist130920CO

General Provider Information

NPI Number : 1124167945
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SHANNON ATKINSON CMT
Provider Business Mailing Address
First Line : 4435 LAVEN WAY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-5747
Country : US
Telephone Number : 719-266-1712
Fax Number :
Provider Business Practice Location Address
First Line : 4435 LAVEN WAY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-5747
Country : US
Telephone Number : 719-266-1712
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 07/08/2007

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Directions to “ MR. SHANNON ATKINSON CMT” Practice Location

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