Provider Demographics
NPI:1316165954
Name:SHORT, GWYNETH (ATC)
Entity type:Individual
Prefix:
First Name:GWYNETH
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 S LEE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-6342
Mailing Address - Country:US
Mailing Address - Phone:303-988-9204
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST STE 616
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3805
Practice Address - Country:US
Practice Address - Phone:303-221-0162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer