Provider Demographics
NPI:1700145356
Name:COLBY, SHALISHA
Entity Type:Individual
Prefix:
First Name:SHALISHA
Middle Name:
Last Name:COLBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9023 PEPPERIDGE LN SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9725
Mailing Address - Country:US
Mailing Address - Phone:253-929-4302
Mailing Address - Fax:
Practice Address - Street 1:8613 MARTIN WAY E
Practice Address - Street 2:SUITE 201
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5820
Practice Address - Country:US
Practice Address - Phone:253-929-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60277314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist