Provider Demographics
NPI:1689736795
Name:CORREA, MARIA DIZON (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DIZON
Last Name:CORREA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N UNION BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2283
Mailing Address - Country:US
Mailing Address - Phone:719-522-1080
Mailing Address - Fax:719-522-0661
Practice Address - Street 1:1901 N UNION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2283
Practice Address - Country:US
Practice Address - Phone:719-522-1080
Practice Address - Fax:719-522-0661
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2537225100000X
CO11066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52462Medicare ID - Type Unspecified