Provider Demographics
NPI:1063472330
Name:BARE, ANTHONY (DPT, OCS, ATC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:BARE
Suffix:
Gender:M
Credentials:DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 GREAT PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1625
Mailing Address - Country:US
Mailing Address - Phone:719-590-7777
Mailing Address - Fax:719-590-7121
Practice Address - Street 1:4025 FAMILY PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7807
Practice Address - Country:US
Practice Address - Phone:719-590-7777
Practice Address - Fax:719-590-7121
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist