MEDICARE: MRS. ANNE L SLACK PHYSICAL THERAPIST

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	7376	CO

General Provider Information

NPI Number	:	1467451542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE L SLACK PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1632A BIG THOMPSON AVE
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-8938
Country	:	US
Telephone Number	:	970-577-8200
Fax Number	:	970-577-8200

Provider Business Practice Location Address
First Line	:	1632A BIG THOMPSON AVE
Second Line	:
City	:	ESTES PARK
State	:	CO
Zip	:	80517-8938
Country	:	US
Telephone Number	:	970-577-8200
Fax Number	:	970-577-8200

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/06/2023

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