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General NPI Number Information
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NPI Number | 1558872267
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Entity Type | Organization
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Legal Business Name | MENDING MOUNTAINS THERAPY PC
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 1345 ROCK CT
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City | CARBONDALE
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State | CO
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Zip | 81623-1893
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Country | US
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Telephone | 612-581-2822
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 ROCK CT
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City | CARBONDALE
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State | CO
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Zip | 81623-1893
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Country | US
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Telephone | 612-581-2822
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. PATRICIA MARIE BEERY
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Credential | PT
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Telephone | 612-581-2822
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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 | 8983
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License Number State | CO
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