Provider Demographics
NPI:1427355254
Name:HADLEY, SHAWN (CMT, ART PROVIDER)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:HADLEY
Suffix:
Gender:M
Credentials:CMT, ART PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CASTLE RDG
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-3128
Mailing Address - Country:US
Mailing Address - Phone:970-987-8877
Mailing Address - Fax:
Practice Address - Street 1:616 E HYMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1981
Practice Address - Country:US
Practice Address - Phone:970-987-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1110225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist