Organization
SHAW ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNELLE NUSPL SHAW PT, MSPT, DPT (GEN PTR)
(303) 514-9912
Entity
Organization
Contact information
Practice address
401 RIO RANCHO WAY, BRIGHTON, CO 80601-3539
(303) 514-9912
Mailing address
401 RIO RANCHO WAY, BRIGHTON, CO 80601-3539
(303) 514-9912
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
8650
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8650
COLORADO DEPARTMENT OF REGULATORY AGENCIES
CO
Enumeration date
01/19/2009
Last updated
01/19/2009
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