Healthcare Provider Details

I. General information

NPI: 1548577810
Provider Name (Legal Business Name): ABUNDANT HEALTH AND REHAB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 AUSTIN BLUFFS PKWY SUITE 110
COLORADO SPRINGS CO
80918-5701
US

IV. Provider business mailing address

3425 AUSTIN BLUFFS PKWY SUITE 110
COLORADO SPRINGS CO
80918-5701
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-0254
  • Fax: 719-630-0256
Mailing address:
  • Phone: 719-630-0254
  • Fax: 719-630-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45066
License Number StateCO

VIII. Authorized Official

Name: DR. JULIE HALLING
Title or Position: CLINIC DIRECTOR
Credential: M.D.
Phone: 719-630-0254