Provider Demographics
NPI:1932321411
Name:REGIONAL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:REGIONAL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNERPHYSICALTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-264-8524
Mailing Address - Street 1:6165 LEHMAN DR
Mailing Address - Street 2:STE 102
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6165 LEHMAN DR
Practice Address - Street 2:STE 102
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5405
Practice Address - Country:US
Practice Address - Phone:719-264-8524
Practice Address - Fax:719-264-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2115261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803878Medicare PIN