Provider Demographics
NPI:1134139611
Name:CHEO, STAN W (PT)
Entity Type:Individual
Prefix:DR
First Name:STAN
Middle Name:W
Last Name:CHEO
Suffix:
Gender:M
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:PO BOX 8696
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81612
Mailing Address - Country:US
Mailing Address - Phone:970-923-9578
Mailing Address - Fax:970-923-9579
Practice Address - Street 1:616 EAST HYMAN AVE
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611
Practice Address - Country:US
Practice Address - Phone:970-925-1808
Practice Address - Fax:970-920-6535
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4348208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066577Medicare ID - Type Unspecified