MEDICARE: MR. DAVID I DOUPHRATE MPT MBA

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	8427	CO

General Provider Information

NPI Number	:	1144253543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID I DOUPHRATE MPT MBA

Provider Business Mailing Address
First Line	:	3938 JOHN F KENNEDY PARKWAY
Second Line	:	SUITE B
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-207-1500
Fax Number	:	970-207-0075

Provider Business Practice Location Address
First Line	:	3938 JOHN F KENNEDY PARKWAY
Second Line	:	SUITE B
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-207-1500
Fax Number	:	970-207-0075

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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