Provider Demographics
NPI:1972040996
Name:PRECISION MANUEL THERAPY AND REHAB LLC
Entity Type:Organization
Organization Name:PRECISION MANUEL THERAPY AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BUECHLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMT
Authorized Official - Phone:719-659-2503
Mailing Address - Street 1:7710 N UNION BLVD STE 100D
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4085
Mailing Address - Country:US
Mailing Address - Phone:719-659-2503
Mailing Address - Fax:
Practice Address - Street 1:7710 N UNION BLVD STE 100D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4085
Practice Address - Country:US
Practice Address - Phone:719-659-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0010450261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherTAX IDENTIFICATION