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NPI Code Detail

MEDICARE: ALICIA RUTH SOUVIGNIER PT

MEDICARE: ALICIA RUTH SOUVIGNIER 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
1225100000XPhysical Therapist2934NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679562417
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA RUTH SOUVIGNIER PT
Provider Business Mailing Address
First Line : 4160 STONEHAVEN DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-4835
Country : US
Telephone Number : 505-215-3094
Fax Number :
Provider Business Practice Location Address
First Line : 1650 COCHRANE CIR UNIT MEDDAC
Second Line :
City : FORT CARSON
State : CO
Zip : 80913-4604
Country : US
Telephone Number : 719-524-5218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 11/01/2023

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Directions to “ ALICIA RUTH SOUVIGNIER PT” Practice Location

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