Healthcare Provider Details

I. General information

NPI: 1710164496
Provider Name (Legal Business Name): IMPACT PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S TEJON ST SUITE 106
COLORADO SPRINGS CO
80906-2267
US

IV. Provider business mailing address

1605 S TEJON ST SUITE 106
COLORADO SPRINGS CO
80906-2267
US

V. Phone/Fax

Practice location:
  • Phone: 719-448-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8038
License Number StateCO

VIII. Authorized Official

Name: MS. ANGIE M ARGUNA
Title or Position: PRESIDENT
Credential: P.T.
Phone: 719-448-0300