Provider Demographics
NPI:1194828798
Name:PEARSON, JOHN T JR (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:PEARSON
Suffix:JR
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 1:440 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2729
Mailing Address - Country:US
Mailing Address - Phone:970-826-4800
Mailing Address - Fax:970-826-4801
Practice Address - Street 1:440 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2729
Practice Address - Country:US
Practice Address - Phone:970-822-6480
Practice Address - Fax:970-826-4801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066581Medicare ID - Type Unspecified