Individual
SHANNAW DALE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
8093 RALEIGH ST, WESTMINSTER, CO 80031-4313
(720) 448-8585
Mailing address
PO BOX 362, DUPONT, CO 80024-0362
(720) 448-8585
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0003584
CO
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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