Provider Demographics
NPI:1376658732
Name:BERG, SHANNON S (CMT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:S
Last Name:BERG
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 BOISE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4295
Mailing Address - Country:US
Mailing Address - Phone:719-510-4233
Mailing Address - Fax:970-663-4524
Practice Address - Street 1:1931 BOISE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4295
Practice Address - Country:US
Practice Address - Phone:719-510-4233
Practice Address - Fax:970-663-4524
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist