Provider Demographics
NPI:1477709236
Name:MEASEL, SHANNON J (CLMT, NMT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:J
Last Name:MEASEL
Suffix:
Gender:M
Credentials:CLMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-1558
Mailing Address - Country:US
Mailing Address - Phone:719-320-9713
Mailing Address - Fax:719-320-9713
Practice Address - Street 1:503 W 4TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-1558
Practice Address - Country:US
Practice Address - Phone:719-320-9713
Practice Address - Fax:719-320-9713
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist