Healthcare Provider Details

I. General information

NPI: 1861873648
Provider Name (Legal Business Name): STRIDES PEDIATRIC PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13754 RIVERCREST CIR
COLORADO SPRINGS CO
80921-3208
US

IV. Provider business mailing address

13754 RIVERCREST CIR
COLORADO SPRINGS CO
80921-3208
US

V. Phone/Fax

Practice location:
  • Phone: 719-433-8380
  • Fax: 719-495-6544
Mailing address:
  • Phone: 719-433-8380
  • Fax: 719-495-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number8703
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8703
License Number StateCO

VIII. Authorized Official

Name: ELIZABETH COBOS-TARIN
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 719-433-8380