Provider Demographics
NPI:1689652240
Name:PLANTE, PHILIP A (PT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:PLANTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2233 ACADEMY PL
Mailing Address - Street 2:SUITE 50
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1696
Mailing Address - Country:US
Mailing Address - Phone:719-475-0808
Mailing Address - Fax:719-475-8822
Practice Address - Street 1:104 PRO RODEO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2334
Practice Address - Country:US
Practice Address - Phone:719-630-3193
Practice Address - Fax:719-630-3195
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2015-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COPT3655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC453408Medicare PIN