Provider Demographics
NPI:1295950491
Name:PINE SPRINGS THERAPY SERVICES
Entity type:Organization
Organization Name:PINE SPRINGS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-716-9701
Mailing Address - Street 1:9603 PINE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2300
Mailing Address - Country:US
Mailing Address - Phone:303-716-9701
Mailing Address - Fax:303-697-1256
Practice Address - Street 1:9603 PINE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2300
Practice Address - Country:US
Practice Address - Phone:303-716-9701
Practice Address - Fax:303-697-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6465225100000X
CO12007532225400000X
CO5758 9062225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57589062Medicaid
CO12075043Medicaid
CO74024060Medicaid
CO92276318Medicaid
CO79437541Medicaid