Provider Demographics
NPI:1346430824
Name:CULLUM, ROBERT DANIEL (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
Last Name:CULLUM
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:MR
Other - First Name:R
Other - Middle Name:DANIEL
Other - Last Name:CULLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT
Mailing Address - Street 1:575 RIVERGATE UNIT 208
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7490
Mailing Address - Country:US
Mailing Address - Phone:970-259-2547
Mailing Address - Fax:970-259-9653
Practice Address - Street 1:575 RIVERGATE UNIT 208
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7490
Practice Address - Country:US
Practice Address - Phone:970-382-8776
Practice Address - Fax:970-382-9746
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO531078Medicare ID - Type Unspecified
COP48782Medicare UPIN