Healthcare Provider Details

I. General information

NPI: 1497394902
Provider Name (Legal Business Name): STEVEN NUTCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PRINTERS PKWY STE 125
COLORADO SPRINGS CO
80910-6102
US

IV. Provider business mailing address

155 PRINTERS PKWY STE 125
COLORADO SPRINGS CO
80910-6102
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-8622
  • Fax: 719-635-8619
Mailing address:
  • Phone: 719-635-8622
  • Fax: 719-635-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0014119
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: