Healthcare Provider Details

I. General information

NPI: 1407165913
Provider Name (Legal Business Name): STEPHANIE NOLTING DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 GLEN ROYAL DR
PUEBLO CO
81005-2263
US

IV. Provider business mailing address

58 GLEN ROYAL DR
PUEBLO CO
81005-2263
US

V. Phone/Fax

Practice location:
  • Phone: 719-565-6678
  • Fax: 888-334-4957
Mailing address:
  • Phone: 719-565-6678
  • Fax: 888-334-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11455
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11455
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: