Provider Demographics
NPI:1679296404
Name:POOLE, SHANNON TAYLOR (DPT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:TAYLOR
Last Name:POOLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 N DOWNING ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2180
Mailing Address - Country:US
Mailing Address - Phone:954-815-0486
Mailing Address - Fax:
Practice Address - Street 1:700 W MINERAL AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4511
Practice Address - Country:US
Practice Address - Phone:720-239-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist