Provider Demographics
NPI:1558688044
Name:COLORADO SPINAL THERAPY
Entity Type:Organization
Organization Name:COLORADO SPINAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-741-4045
Mailing Address - Street 1:7075 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-6523
Mailing Address - Country:US
Mailing Address - Phone:303-741-4045
Mailing Address - Fax:303-484-7767
Practice Address - Street 1:7075 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-6523
Practice Address - Country:US
Practice Address - Phone:303-741-4045
Practice Address - Fax:303-484-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty