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General NPI Number Information
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NPI Number | 1558688044
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Entity Type | Organization
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Legal Business Name | COLORADO SPINAL THERAPY
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 7075 CAMPUS DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-6523
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Country | US
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Telephone | 303-741-4045
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Fax | 303-484-7767
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Provider Business Mailing Address
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Address Line | 7075 CAMPUS DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-6523
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Country | US
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Telephone | 303-741-4045
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Fax | 303-484-7767
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. ROBERT C WALFORD
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Credential | P.T.
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Telephone | 303-741-4045
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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 | 5729
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License Number State | CO
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