Individual
JOHNELLE NUSPL SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, MSPT, DPT
Contact information
Practice address
1021 STAGECOACH DR, LAFAYETTE, CO 80026-8703
(303) 514-9912
Mailing address
1021 STAGECOACH DR, LAFAYETTE, CO 80026-8703
(303) 514-9912
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
8650
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33972273
—
CO
Enumeration date
06/18/2008
Last updated
10/07/2020
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