Healthcare Provider Details

I. General information

NPI: 1770852006
Provider Name (Legal Business Name): EDGE REHABILITATION & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 HOLLOW BROOK DR SUITE 100
COLORADO SPRINGS CO
80918-8413
US

IV. Provider business mailing address

2150 HOLLOW BROOK DR SUITE 100
COLORADO SPRINGS CO
80918-8413
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-5330
  • Fax: 719-599-5438
Mailing address:
  • Phone: 719-599-5330
  • Fax: 719-599-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW MARCHMAN
Title or Position: OWNER
Credential: PT
Phone: 719-433-0496