Basic Information
| Provider Information | |||||||||
| NPI: | 1558606764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIELSON | ||||||||
| FirstName: | SHANYN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FIALKOV | ||||||||
| OtherFirstName: | SHANYN | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6612 S WARD ST | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801274855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034092133 | ||||||||
| FaxNumber: | 3034092233 | ||||||||
| Practice Location | |||||||||
| Address1: | 10485 SHERIDAN BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800204101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034092133 | ||||||||
| FaxNumber: | 3034092233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 20186 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PTL0013752 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.