Provider Demographics
NPI:1326062407
Name:WEST, GWEN SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:SUE
Last Name:WEST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:SUE
Other - Last Name:AKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-9000
Mailing Address - Country:US
Mailing Address - Phone:719-553-2209
Mailing Address - Fax:719-553-2219
Practice Address - Street 1:3676 PARKER BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2212
Practice Address - Country:US
Practice Address - Phone:719-553-2209
Practice Address - Fax:719-553-2219
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55500579Medicaid
CO55500579Medicaid