Healthcare Provider Details

I. General information

NPI: 1396017240
Provider Name (Legal Business Name): 4US2HEAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W KIOWA ST
COLORADO SPRINGS CO
80905-1422
US

IV. Provider business mailing address

PO BOX 2354
COLORADO SPRINGS CO
80901-2354
US

V. Phone/Fax

Practice location:
  • Phone: 719-271-4583
  • Fax:
Mailing address:
  • Phone: 719-634-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2067
License Number StateCO

VIII. Authorized Official

Name: MS. DONNA RAE DAGUE
Title or Position: MANAGING THERAPIST
Credential: OTR/L
Phone: 719-634-1380