Healthcare Provider Details

I. General information

NPI: 1003926585
Provider Name (Legal Business Name): SCOTT REZAC PT, DPT, OCS, CSCS,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 N UNION BLVD STE A
COLORADO SPRINGS CO
80909-2268
US

IV. Provider business mailing address

6444 MORNING DOVE DR
COLORADO SPRINGS CO
80923-4441
US

V. Phone/Fax

Practice location:
  • Phone: 719-465-1502
  • Fax:
Mailing address:
  • Phone: 719-380-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8589
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: