Provider Demographics
NPI:1730284068
Name:SHANAHAN, HEATHER MATHESON (MSPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MATHESON
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MATHESON
Other - Last Name:HOTCHKISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:6979 S HOLLY CIR
Mailing Address - Street 2:STE 105
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1577
Mailing Address - Country:US
Mailing Address - Phone:303-694-2295
Mailing Address - Fax:303-694-1843
Practice Address - Street 1:333 S ALLISON PKWY
Practice Address - Street 2:STE 305
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3129
Practice Address - Country:US
Practice Address - Phone:303-237-7715
Practice Address - Fax:303-237-1157
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
102255323OtherOWCP FACILITY ID
COC805017Medicare PIN
COCO303418Medicare PIN