Provider Demographics
NPI:1174634935
Name:ANSELL, RICHARD CHAD (DPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CHAD
Last Name:ANSELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 TUTT BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3502
Mailing Address - Country:US
Mailing Address - Phone:719-596-0880
Mailing Address - Fax:719-596-0899
Practice Address - Street 1:6140 TUTT BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3576
Practice Address - Country:US
Practice Address - Phone:719-596-0880
Practice Address - Fax:719-596-0899
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C494358Medicare ID - Type Unspecified
P86334Medicare UPIN