Provider Demographics
NPI:1710038666
Name:THOMAS, SHELLEY R (PT)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:3605 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6672
Mailing Address - Country:US
Mailing Address - Phone:719-265-6601
Mailing Address - Fax:719-265-6649
Practice Address - Street 1:1230 TENDERFOOT HILL RD
Practice Address - Street 2:SUITE 155
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-7346
Practice Address - Country:US
Practice Address - Phone:719-527-3383
Practice Address - Fax:719-527-2688
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO3665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA3665Medicare PIN