Provider Demographics
NPI:1720229644
Name:ZELENKA, SHANNON MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARIE
Last Name:ZELENKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-2105
Mailing Address - Country:US
Mailing Address - Phone:970-309-4706
Mailing Address - Fax:970-704-6834
Practice Address - Street 1:900 COOPER AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3666
Practice Address - Country:US
Practice Address - Phone:970-309-4706
Practice Address - Fax:970-704-6834
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75932251X0800X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic