Healthcare Provider Details

I. General information

NPI: 1245770874
Provider Name (Legal Business Name): STEPHANIE NEAL KURICA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W PUEBLO BLVD
PUEBLO CO
81004-3866
US

IV. Provider business mailing address

2237 US HIGHWAY 2 E SUITE B
KALISPELL MT
59901-2812
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-0589
  • Fax: 719-542-0119
Mailing address:
  • Phone: 855-456-7146
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0014588
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: