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General NPI Number Information
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NPI Number | 1003926585
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Entity Type | Individual
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Provider Name | SCOTT REZAC PT, DPT, OCS, CSCS,
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 1817 N UNION BLVD STE A
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-2268
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Country | US
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Telephone | 719-465-1502
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Fax |
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Provider Business Mailing Address
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Address Line | 6444 MORNING DOVE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-4441
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Country | US
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Telephone | 719-380-9978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8589
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License Number State | CO
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