Provider Demographics
NPI:1689900680
Name:FONTE, SHANA (PT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:FONTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14535 W DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5494
Mailing Address - Country:US
Mailing Address - Phone:303-985-3383
Mailing Address - Fax:
Practice Address - Street 1:14535 W DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-5494
Practice Address - Country:US
Practice Address - Phone:303-985-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37762251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics