Provider Demographics
NPI:1497734313
Name:CHURCH, KAREN (RPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 0541
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0541
Mailing Address - Country:US
Mailing Address - Phone:970-945-1443
Mailing Address - Fax:970-947-9410
Practice Address - Street 1:710 COOPER AVE STE 100
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3446
Practice Address - Country:US
Practice Address - Phone:970-945-6971
Practice Address - Fax:970-928-7975
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH15793OtherBLUE CROSS
COCO301114Medicare PIN