Provider Demographics
NPI:1760543490
Name:STEAMBOAT SPINE AND SPORTS INC.
Entity Type:Organization
Organization Name:STEAMBOAT SPINE AND SPORTS INC.
Other - Org Name:STEPHANIE LOOMIS PT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FINN
Authorized Official - Middle Name:BURNETT
Authorized Official - Last Name:GERSTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-879-7031
Mailing Address - Street 1:1560 PINE GROVE RD STE B
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8006
Mailing Address - Country:US
Mailing Address - Phone:970-879-7031
Mailing Address - Fax:970-879-4928
Practice Address - Street 1:1560 PINE GROVE RD STE B
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-879-7031
Practice Address - Fax:970-879-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34302081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC21113Medicare ID - Type Unspecified