Healthcare Provider Details

I. General information

NPI: 1689046658
Provider Name (Legal Business Name): COLBY SCHRODER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR
COLORADO SPRINGS CO
80920-7502
US

IV. Provider business mailing address

4175 WESTMEADOW DR APT #1183
COLORADO SPRINGS CO
80906-6081
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax:
Mailing address:
  • Phone: 720-810-4384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number13582
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: