Provider Demographics
NPI:1356326433
Name:STOOT, FREDRICK J (PT)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:J
Last Name:STOOT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2233 ACADEMY PLACE
Mailing Address - Street 2:STE 50
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-475-0808
Mailing Address - Fax:719-475-8822
Practice Address - Street 1:2955 PROFESSIONAL PL
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-8139
Practice Address - Country:US
Practice Address - Phone:719-227-7079
Practice Address - Fax:719-227-7079
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPT4045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO453388Medicare PIN