Healthcare Provider Details

I. General information

NPI: 1760543490
Provider Name (Legal Business Name): STEAMBOAT SPINE AND SPORTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 PINE GROVE RD STE B
STEAMBOAT SPRINGS CO
80487
US

IV. Provider business mailing address

1560 PINE GROVE RD STE B
STEAMBOAT SPRINGS CO
80487-8006
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-7031
  • Fax: 970-879-4928
Mailing address:
  • Phone: 970-879-7031
  • Fax: 970-879-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number3430
License Number StateCO

VIII. Authorized Official

Name: FINN BURNETT GERSTELL
Title or Position: PRESIDENT
Credential:
Phone: 970-879-7031