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General NPI Number Information
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NPI Number | 1154477065
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Entity Type | Organization
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Legal Business Name | CANON CITY PHYSIOTHERAPY INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 1107 MAIN ST
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City | CANON CITY
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State | CO
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Zip | 81212-3413
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Country | US
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Telephone | 719-269-1142
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Fax | 719-269-1413
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Provider Business Mailing Address
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Address Line | 1107 MAIN ST
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City | CANON CITY
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State | CO
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Zip | 81212-3413
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Country | US
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Telephone | 719-269-1142
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Fax | 719-269-1413
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Authorized Official
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Title or Position | OWNER
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Name | MR. PAUL WAYNE PASCHALL
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Credential | P.T.
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Telephone | 719-269-1142
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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 | 6141
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5795
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License Number State | CO
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