Healthcare Provider Details

I. General information

NPI: 1821854316
Provider Name (Legal Business Name): MARISSA VEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 QUAIL LAKE LOOP STE 100
COLORADO SPRINGS CO
80906-4651
US

IV. Provider business mailing address

1330 QUAIL LAKE LOOP STE 100
COLORADO SPRINGS CO
80906-4651
US

V. Phone/Fax

Practice location:
  • Phone: 719-579-0230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP054865T
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2633
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: