Provider Demographics
NPI:1942548839
Name:NORTHGATE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:NORTHGATE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:STORY
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:719-247-8916
Mailing Address - Street 1:PO BOX 63113
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-3113
Mailing Address - Country:US
Mailing Address - Phone:719-247-8916
Mailing Address - Fax:719-247-8930
Practice Address - Street 1:16055 OLD FOREST PT
Practice Address - Street 2:SUITE 101B
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8670
Practice Address - Country:US
Practice Address - Phone:719-247-8916
Practice Address - Fax:719-247-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8499261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy