MEDICARE: CASSANDRA LEE SHAWCROSS PTA

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
1	225200000X	Physical Therapy Assistant	PTA.0012213	CO

General Provider Information

NPI Number	:	1659680379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA LEE SHAWCROSS PTA

Provider Business Mailing Address
First Line	:	1805 104TH AVENUE CT
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80634-4825
Country	:	US
Telephone Number	:	303-349-6558
Fax Number	:

Provider Business Practice Location Address
First Line	:	11409 BUSINESS PARK CIR STE 200
Second Line	:
City	:	FIRESTONE
State	:	CO
Zip	:	80504-9203
Country	:	US
Telephone Number	:	720-727-1141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	06/04/2026

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