=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477038206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN DAORAI PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2018
-----------------------------------------------------
Last Update Date | 09/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8540 SCARBOROUGH DR STE 200
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-7513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-632-8325
-----------------------------------------------------
Fax | 719-630-8099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4560 S BALSAM WAY APT 5307
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80123-7347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-732-6637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 0015597
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------