Provider Demographics
NPI:1578556262
Name:BAUMGARTNER, MELISSA D (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:D
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-5012
Mailing Address - Country:US
Mailing Address - Phone:970-879-7799
Mailing Address - Fax:970-879-1262
Practice Address - Street 1:CENTRAL PARK PLAZA
Practice Address - Street 2:SUITE 206
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-879-7799
Practice Address - Fax:970-879-1262
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5157225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066607Medicare Oscar/Certification