Provider Demographics
NPI:1851714505
Name:SHANK, LAURA ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:SHANK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:602 ELKTON DR # 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3514
Mailing Address - Country:US
Mailing Address - Phone:719-559-0680
Mailing Address - Fax:719-559-0681
Practice Address - Street 1:602 ELKTON DR # 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3514
Practice Address - Country:US
Practice Address - Phone:719-559-0681
Practice Address - Fax:719-559-0680
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1288773225100000X
CO19712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400129434Medicare PIN