MEDICARE: SIERRA ALEXANDRA STOUT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3855	NM

General Provider Information

NPI Number	:	1083971170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA ALEXANDRA STOUT PT

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 150
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:	970-624-4128
Fax Number	:	970-490-4340

Provider Business Practice Location Address
First Line	:	200 LINCOLN AVE UNIT 771211
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-6648
Country	:	US
Telephone Number	:	970-457-1191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	06/29/2021

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