Healthcare Provider Details

I. General information

NPI: 1245212711
Provider Name (Legal Business Name): PUEBLO REHAB & ORTHOPEDIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 SPAULDING AVE
PUEBLO CO
81008-2208
US

IV. Provider business mailing address

3525 SPAULDING AVENUE
PUEBLO CO
81008
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-4444
  • Fax: 719-543-1990
Mailing address:
  • Phone: 719-542-4444
  • Fax: 719-543-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS LYNDSEY BROOKE LANGDON
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-542-4444