MEDICARE: SHANNON LEE LOPEZ 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
1	225700000X	Massage Therapist	3098	CO

General Provider Information

NPI Number	:	1962732701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LEE LOPEZ CMT

Provider Business Mailing Address
First Line	:	3189 W CALYPSO CT
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-2826
Country	:	US
Telephone Number	:	720-296-9182
Fax Number	:

Provider Business Practice Location Address
First Line	:	3189 W CALYPSO CT
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-2826
Country	:	US
Telephone Number	:	720-296-9182
Fax Number	:

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

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	12/29/2009

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