1689651937 NPI number — KAREN CHURCH PHYSICAL THERAPY P C

Table of content: (NPI 1689651937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689651937 NPI number — KAREN CHURCH PHYSICAL THERAPY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAREN CHURCH PHYSICAL THERAPY P C
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:
1689651937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 0541
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD SPGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81602-0541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-945-1443
Provider Business Mailing Address Fax Number:
970-947-9410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 COOPER AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD SPGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81601-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-945-6971
Provider Business Practice Location Address Fax Number:
970-928-7975
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHURCH
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT PHYSICAL THERAPIST
Authorized Official Telephone Number:
970-945-6971

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3618 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH15793 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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