Healthcare Provider Details

I. General information

NPI: 1124072566
Provider Name (Legal Business Name): DOUGLAS EMERSON PT, DPT, OCS, CMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR
VAIL CO
81657-5242
US

IV. Provider business mailing address

PO BOX 40000
VAIL CO
81658-7520
US

V. Phone/Fax

Practice location:
  • Phone: 970-328-6730
  • Fax:
Mailing address:
  • Phone: 207-944-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2914
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number35656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: