Healthcare Provider Details

I. General information

NPI: 1265733463
Provider Name (Legal Business Name): LORELEI DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
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

9 ELK PATH
MANITOU SPRINGS CO
80829-2112
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number10973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: