Healthcare Provider Details

I. General information

NPI: 1053485193
Provider Name (Legal Business Name): PENROSE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5000
  • Fax:
Mailing address:
  • Phone: 719-776-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4068
License Number StateCO

VIII. Authorized Official

Name: MRS. VICKI LIEBER LIEBER
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 719-776-5652