Provider Demographics
NPI:1043461882
Name:COLWELL, SHAWNA GAYE (LMT, LET)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:GAYE
Last Name:COLWELL
Suffix:
Gender:F
Credentials:LMT, LET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-1717
Mailing Address - Country:US
Mailing Address - Phone:309-657-7753
Mailing Address - Fax:
Practice Address - Street 1:300 W PINE ST STE 2
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-1849
Practice Address - Country:US
Practice Address - Phone:309-657-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227000314172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist