Provider Demographics
NPI:1720147804
Name:SCULLY, ANN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:SCULLY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CROSSING DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2629
Mailing Address - Country:US
Mailing Address - Phone:303-665-8747
Mailing Address - Fax:303-926-0184
Practice Address - Street 1:511 CROSSING DR STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2629
Practice Address - Country:US
Practice Address - Phone:303-665-8747
Practice Address - Fax:303-926-0184
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO499648Medicare ID - Type Unspecified