Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT9710 | GA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 16832 | CO |
NPI | 1043441017 |
---|---|
Provider Name | Jessica Shanahan Leivers |
First Address | Colorado Springs, CO 80923-3502 |
Second Address | Colorado Springs, CO 80923-3502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2009 |
Last Update Date | 07/04/2020 |