Provider Demographics
NPI:1689651937
Name:KAREN CHURCH PHYSICAL THERAPY P C
Entity Type:Organization
Organization Name:KAREN CHURCH PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:970-945-6971
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH15793OtherBLUE CROSS
CH15793OtherBLUE CROSS