Provider Demographics
NPI:1942604673
Name:GAISFORD, ROBERT (MMEDSC, ATC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GAISFORD
Suffix:
Gender:M
Credentials:MMEDSC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLYMPIC PLAZA
Mailing Address - Street 2:SPORTS MEDICINE/OLYMPIC TRAINING CENTER
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-866-4554
Mailing Address - Fax:
Practice Address - Street 1:1 OLYMPIC PLAZA
Practice Address - Street 2:SPORTS MEDICINE/OLYMPIC TRAINING CENTER
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-866-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAT.0001221OtherCOLORADO REGISTRATION
2000006551OtherNATABOC