Healthcare Provider Details

I. General information

NPI: 1881064483
Provider Name (Legal Business Name): PAULA SPILSBURY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 E PRENTICE AVE STE 207
GREENWOOD VILLAGE CO
80111-2905
US

IV. Provider business mailing address

12440 EAGLE DR
BURLINGTON WA
98233-2795
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax:
Mailing address:
  • Phone: 360-421-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number09015
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP1 60433306
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: