Provider Demographics
NPI:1508100702
Name:HITCH RODRIGUEZ, SHALANE VENICE (DPT)
Entity Type:Individual
Prefix:
First Name:SHALANE
Middle Name:VENICE
Last Name:HITCH RODRIGUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8979 BELLSONG DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-1880
Mailing Address - Country:US
Mailing Address - Phone:316-992-5442
Mailing Address - Fax:
Practice Address - Street 1:1035 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3904
Practice Address - Country:US
Practice Address - Phone:316-992-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist