Individual
SHELLY CHARLENE WALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4860 MANZANA DR, APT. 210, COLORADO SPRINGS, CO 80911-3015
(719) 459-9789
Mailing address
4860 MANZANA DR, APT. 210, COLORADO SPRINGS, CO 80911-3015
(719) 459-9789
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT0014438
CO
Other
Enumeration date
07/01/2013
Last updated
07/01/2013
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