| NPI | 1255746939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA WONNACOTT Credentialing 719-302-3375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 2134) |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2022-08-16 |