Individual
SHANNON MORELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
214 4TH ST, KREMMLING, CO 80459
(970) 724-3442
Mailing address
485 MEADOW WOOD CIR, DILLON, CO 80435-8485
(316) 992-2505
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
PTA.0014974
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104357707
EMPLOYER
CO
Enumeration date
09/14/2021
Last updated
09/14/2021
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