1952471856 NPI number — SAN JUAN HAND THERAPY, INC.

Table of content: (NPI 1952471856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952471856 NPI number — SAN JUAN HAND THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN JUAN HAND THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952471856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 RIVERGATE LANE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-7490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-247-7711
Provider Business Mailing Address Fax Number:
970-247-1415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 RIVERGATE LANE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-7490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-247-7711
Provider Business Practice Location Address Fax Number:
970-247-1415
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINNOTT-OSWALD
Authorized Official First Name:
MARY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-247-7711

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19001754 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 670002078 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com