Provider Demographics
NPI:1790750008
Name:PRO-REHAB AND FITNESS CENTER, INC.
Entity Type:Organization
Organization Name:PRO-REHAB AND FITNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-846-8668
Mailing Address - Street 1:323 N COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2611
Mailing Address - Country:US
Mailing Address - Phone:719-846-8668
Mailing Address - Fax:719-846-8629
Practice Address - Street 1:323 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2611
Practice Address - Country:US
Practice Address - Phone:719-846-8668
Practice Address - Fax:719-846-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46889001Medicaid
CO46889001Medicaid