Provider Demographics
NPI:1023690799
Name:SPINELLA, RICHARD JOHN JR (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOHN
Last Name:SPINELLA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1014
Mailing Address - Country:US
Mailing Address - Phone:970-349-2817
Mailing Address - Fax:970-349-2779
Practice Address - Street 1:426 BELLEVIEW AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-349-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist