Provider Demographics
NPI:1699590570
Name:SHURGOT, HANNAH (MT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:SHURGOT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 TRUMPETERS CT W
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2826
Mailing Address - Country:US
Mailing Address - Phone:719-663-4881
Mailing Address - Fax:
Practice Address - Street 1:6270 LEHMAN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1469
Practice Address - Country:US
Practice Address - Phone:719-663-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0026682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist