Healthcare Provider Details

I. General information

NPI: 1689651937
Provider Name (Legal Business Name): KAREN CHURCH PHYSICAL THERAPY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 COOPER AVE STE 100
GLENWOOD SPGS CO
81601-3446
US

IV. Provider business mailing address

PO BOX 0541
GLENWOOD SPGS CO
81602-0541
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-6971
  • Fax: 970-928-7975
Mailing address:
  • Phone: 970-945-1443
  • Fax: 970-947-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3618
License Number StateCO

VIII. Authorized Official

Name: KAREN CHURCH
Title or Position: PRESIDENT PHYSICAL THERAPIST
Credential: RPT
Phone: 970-945-6971