Provider Demographics
NPI:1790113686
Name:ALLSTOTT, SHANNON (RMT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ALLSTOTT
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 COCKLEBUR LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4366
Mailing Address - Country:US
Mailing Address - Phone:970-231-7689
Mailing Address - Fax:
Practice Address - Street 1:148 W OAK ST STE C
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2893
Practice Address - Country:US
Practice Address - Phone:970-829-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0002002225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist