Provider Demographics
NPI:1801868971
Name:LARUE, PAULETTE KIMBERLY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:KIMBERLY
Last Name:LARUE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6385 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-5901
Mailing Address - Country:US
Mailing Address - Phone:719-380-1100
Mailing Address - Fax:828-670-8057
Practice Address - Street 1:6385 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-5901
Practice Address - Country:US
Practice Address - Phone:828-670-8056
Practice Address - Fax:828-670-8057
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC62842251P0200X, 225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211608Medicaid
9370547OtherPHCS
NC079HJOtherBCBS
NCD7567OtherMEDCOST