Provider Demographics
NPI:1023007895
Name:MCREYNOLDS, ROSE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:ROSE MARIE
Middle Name:
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 E 9TH AVE
Mailing Address - Street 2:ATTN ROSE INPATIENT REHAB
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3908
Mailing Address - Country:US
Mailing Address - Phone:303-320-2818
Mailing Address - Fax:303-320-7117
Practice Address - Street 1:4567 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3908
Practice Address - Country:US
Practice Address - Phone:303-320-2818
Practice Address - Fax:303-320-7117
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18824064Medicaid
CO066615OtherMEDICARE GROUP #
CO86723251OtherMEDICAID PRACTICE GROUP #