Active NPI
Shaun English Weakley, LMT
- Massage Therapist
- Pueblo, CO
National Provider Identifier
1003539644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT.0018186
- Practice address
- 108 W 5TH St
Pueblo, CO 81003-3118 - Phone
- (719) 621-8374
- NPI assigned
- Sep 20, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT.0018186 | CO | Primary |
Addresses
Primary practice location
108 W 5TH St
Pueblo, CO 81003-3118
Mailing address
108 W 5TH St
Pueblo, CO 81003-3118
Phone (719) 621-8374
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | CO | NA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | weakleyent@gmail.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT.0018186 | CO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663632000000",
"number": "1003539644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 W 5TH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810033118",
"telephone_number": "719-621-8374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 W 5TH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810033118",
"telephone_number": "719-621-8374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEAKLEY",
"first_name": "SHAUN",
"middle_name": "ENGLISH",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-20",
"last_updated": "2022-09-20",
"certification_date": "2022-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CO",
"license": "MT.0018186",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NA",
"identifier": "NA",
"state": "CO"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "weakleyent@gmail.com",
"affiliation": "N",
"address_1": "108 W 5th St",
"city": "Pueblo",
"state": "CO",
"country_code": "US",
"postal_code": "810033118",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.