Provider Demographics
NPI:1801815766
Name:SPECTRUM REHABILITATION INC
Entity Type:Organization
Organization Name:SPECTRUM REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OP
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-444-0381
Mailing Address - Street 1:810 ARCTURUS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7846
Mailing Address - Country:US
Mailing Address - Phone:719-444-0381
Mailing Address - Fax:719-444-0218
Practice Address - Street 1:810 ARCTURUS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-7846
Practice Address - Country:US
Practice Address - Phone:719-444-0381
Practice Address - Fax:719-444-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803708Medicare UPIN