Provider Demographics
NPI:1003539644
Name:WEAKLEY, SHAUN ENGLISH (LMT)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:ENGLISH
Last Name:WEAKLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3118
Mailing Address - Country:US
Mailing Address - Phone:719-621-8374
Mailing Address - Fax:
Practice Address - Street 1:108 W 5TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3118
Practice Address - Country:US
Practice Address - Phone:719-621-8374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018186225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONAOtherNA