Provider Demographics
NPI:1245212711
Name:PUEBLO REHAB & ORTHOPEDIC THERAPY LLC
Entity Type:Organization
Organization Name:PUEBLO REHAB & ORTHOPEDIC THERAPY LLC
Other - Org Name:PRO THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-542-4444
Mailing Address - Street 1:3525 SPAULDING AVENUE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008
Mailing Address - Country:US
Mailing Address - Phone:719-542-4444
Mailing Address - Fax:719-543-1990
Practice Address - Street 1:3525 SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2208
Practice Address - Country:US
Practice Address - Phone:719-542-4444
Practice Address - Fax:719-543-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
187602900OtherDOL
COCK6274OtherRAILROAD
PU653628OtherBLUE SHIELD
187602900OtherDOL