Healthcare Provider Details

I. General information

NPI: 1952329997
Provider Name (Legal Business Name): EASTERN PLAINS THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56171 E COLFAX UNIT #6
STRASBURG CO
80136
US

IV. Provider business mailing address

PO BOX 491
STRASBURG CO
80136-0491
US

V. Phone/Fax

Practice location:
  • Phone: 303-622-6688
  • Fax:
Mailing address:
  • Phone: 303-622-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD HENDRICKS
Title or Position: OWNER
Credential: PT,DPT,ATC
Phone: 303-622-6688