Provider Demographics
NPI:1134330293
Name:SHEA, KAT A (CMT, NMT, CHOM)
Entity Type:Individual
Prefix:MS
First Name:KAT
Middle Name:A
Last Name:SHEA
Suffix:
Gender:F
Credentials:CMT, NMT, CHOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 BROADWAY ST STE 22
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3196
Mailing Address - Country:US
Mailing Address - Phone:303-447-0474
Mailing Address - Fax:
Practice Address - Street 1:3011 BROADWAY ST STE 22
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3196
Practice Address - Country:US
Practice Address - Phone:303-447-0474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist