Provider Demographics
NPI:1609353879
Name:LEE, SHANAN ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:SHANAN
Middle Name:ELIZABETH
Last Name:LEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 TENDERFOOT HILL RD STE 155
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7346
Mailing Address - Country:US
Mailing Address - Phone:719-527-3383
Mailing Address - Fax:719-527-2688
Practice Address - Street 1:1230 TENDERFOOT HILL RD STE 155
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-7346
Practice Address - Country:US
Practice Address - Phone:719-527-3383
Practice Address - Fax:719-527-2688
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20991225700000X
CO19821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist