Provider Demographics
NPI:1134651458
Name:RYCHLEC, STEPHANIE (MAT, ATC, OTC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RYCHLEC
Suffix:
Gender:F
Credentials:MAT, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 BLACK RIDGE VW APT 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-4455
Mailing Address - Country:US
Mailing Address - Phone:303-906-8069
Mailing Address - Fax:
Practice Address - Street 1:4110 BRIARGATE PKWY STE 145
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7836
Practice Address - Country:US
Practice Address - Phone:719-622-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT59112255A2300X
COAT.00018082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer