Provider Demographics
NPI:1922308238
Name:ANDERSON, SHAWNA LYNN (MPT)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 S COLLEGE AVE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4100
Mailing Address - Country:US
Mailing Address - Phone:970-541-9050
Mailing Address - Fax:866-488-6550
Practice Address - Street 1:1318 S COLLEGE AVE
Practice Address - Street 2:UNIT 5
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4100
Practice Address - Country:US
Practice Address - Phone:970-541-9050
Practice Address - Fax:866-488-6550
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.16506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty