Provider Demographics
NPI:1073329306
Name:PRICE, SHAWN EDWARD (LMT)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:EDWARD
Last Name:PRICE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11207 TUMBLEWEED WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7353
Mailing Address - Country:US
Mailing Address - Phone:720-663-7160
Mailing Address - Fax:
Practice Address - Street 1:7400 E ARAPAHOE RD STE 150
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1280
Practice Address - Country:US
Practice Address - Phone:720-663-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0026926225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty