Provider Demographics
NPI:1477668838
Name:PACE, TREVOR LAWRENCE (MS DPT PT)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:LAWRENCE
Last Name:PACE
Suffix:
Gender:M
Credentials:MS DPT PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1800 30TH STREET
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1026
Mailing Address - Country:US
Mailing Address - Phone:303-546-9201
Mailing Address - Fax:303-545-5080
Practice Address - Street 1:1800 30TH STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1026
Practice Address - Country:US
Practice Address - Phone:303-546-9201
Practice Address - Fax:303-545-5080
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO6216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
802438Medicare ID - Type Unspecified