Healthcare Provider Details

I. General information

NPI: 1457414112
Provider Name (Legal Business Name): UTIV THETCHAYA PHIPPS CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 RAPTOR CREST BLVD
COLORADO SPRINGS CO
80916-5709
US

IV. Provider business mailing address

4919 RAPTOR CREST BLVD
COLORADO SPRINGS CO
80916-5709
US

V. Phone/Fax

Practice location:
  • Phone: 719-331-9060
  • Fax: 719-391-1455
Mailing address:
  • Phone: 719-331-9060
  • Fax: 719-391-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number2352
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: