Provider Demographics
NPI:1235763988
Name:STAPLETON, SHANNA SUZANNE (LMT)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:SUZANNE
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 15TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6348
Mailing Address - Country:US
Mailing Address - Phone:303-807-9973
Mailing Address - Fax:
Practice Address - Street 1:3333 IRIS AVE STE 207
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1998
Practice Address - Country:US
Practice Address - Phone:303-807-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist