Provider Demographics
NPI:1457344319
Name:THE CENTER FOR SPORTS MEDICINE & REHABILITATION, PC
Entity Type:Organization
Organization Name:THE CENTER FOR SPORTS MEDICINE & REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:970-879-7799
Mailing Address - Street 1:100 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-5012
Mailing Address - Country:US
Mailing Address - Phone:970-879-7799
Mailing Address - Fax:970-879-1262
Practice Address - Street 1:100 PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-5012
Practice Address - Country:US
Practice Address - Phone:970-879-7799
Practice Address - Fax:970-879-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066607Medicare ID - Type Unspecified
CO066607Medicare Oscar/Certification