Provider Demographics
NPI:1467451542
Name:SLACK, ANNE L (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:L
Last Name:SLACK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632A BIG THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-8938
Mailing Address - Country:US
Mailing Address - Phone:970-577-8200
Mailing Address - Fax:970-577-8200
Practice Address - Street 1:1632A BIG THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-8938
Practice Address - Country:US
Practice Address - Phone:970-577-8200
Practice Address - Fax:970-577-8200
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO465318Medicare ID - Type UnspecifiedMEDICARE #
CO465328Medicare ID - Type UnspecifiedBUSINESS GROUP MEDICARE #