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General NPI Number Information
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NPI Number | 1134270085
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Entity Type | Organization
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Legal Business Name | RED LADY SPINE & SPORTS PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 427 BELLEVIEW AVE. SUITE 105
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City | CRESTED BUTTE
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State | CO
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Zip | 81224-1117
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Country | US
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Telephone | 970-349-2772
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Fax | 970-349-0459
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Provider Business Mailing Address
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Address Line | PO BOX 1117
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City | CRESTED BUTTE
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State | CO
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Zip | 81224-1117
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Country | US
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Telephone | 970-349-2772
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Fax | 970-349-0459
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. SHELLEY R THOMAS
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Credential | PT
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Telephone | 97803492772
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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 | 3665
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License Number State | CO
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