Individual
SHANE KENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
31 LAKEVIEW LN, WOODLAND PARK, CO 80863-8731
(402) 658-4961
Mailing address
31 LAKEVIEW LN, WOODLAND PARK, CO 80863-8731
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0013001
CO
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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