Individual
DR. BENNETT SHAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4224 N NEVADA AVE STE 200, COLORADO SPRINGS, CO 80907-4368
(719) 900-1817
Mailing address
4082 WARTHOG HTS, COLORADO SPRINGS, CO 80916-3402
(214) 232-2289
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0017676
CO
Other
Enumeration date
09/27/2017
Last updated
05/02/2024
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