Healthcare Provider Details

I. General information

NPI: 1457657553
Provider Name (Legal Business Name): JOANNE REARDANZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7665 ASSISI HEIGHTS MOUNT ST FRANCIS
COLORADO SPRINGS CO
80919
US

IV. Provider business mailing address

2440 LUMBERJACK DR
COLORADO SPRINGS CO
80920-1446
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-1336
  • Fax:
Mailing address:
  • Phone: 719-599-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number6778
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: