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General NPI Number Information
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NPI Number | 1538238399
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Entity Type | Organization
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Legal Business Name | CORTEZ PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 121 RAILROAD AVE
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City | MANCOS
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State | CO
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Zip | 81328-9059
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Country | US
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Telephone | 970-533-7649
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Fax | 970-533-9089
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Provider Business Mailing Address
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Address Line | 121 RAILROAD AVE
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City | MANCOS
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State | CO
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Zip | 81328-9059
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Country | US
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Telephone | 970-533-7649
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Fax | 970-533-9089
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANNETTE M. MULLIKIN
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Credential | P.T.
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Telephone | 970-533-7649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | 1930 PHYSICL THERAP
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License Number State | CO
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