Provider Demographics
NPI:1972981769
Name:SALE, SHANE (LMT)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:SALE
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 1:16434 E ADRIATIC PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-1105
Mailing Address - Country:US
Mailing Address - Phone:720-939-3585
Mailing Address - Fax:
Practice Address - Street 1:16434 E ADRIATIC PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-1105
Practice Address - Country:US
Practice Address - Phone:720-939-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0001571225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist