Healthcare Provider Details

I. General information

NPI: 1295198067
Provider Name (Legal Business Name): SOUTHERN COLORADO HEALTH & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W PUEBLO BLVD
PUEBLO CO
81004
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-0589
  • Fax: 719-542-0119
Mailing address:
  • Phone: 406-756-0134
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BLAINE STIMAC
Title or Position: MANAGING PARTNER
Credential: MSPT
Phone: 406-756-1128