Provider Demographics
NPI:1114275286
Name:HASTINGS, ROBERT E III
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:HASTINGS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41020 ROAD 38
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-9512
Mailing Address - Country:US
Mailing Address - Phone:970-882-2347
Mailing Address - Fax:
Practice Address - Street 1:211 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328-9079
Practice Address - Country:US
Practice Address - Phone:970-533-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist