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General NPI Number Information
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NPI Number | 1588772305
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN REHAB ASSOC IN
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 559 E PIKES PEAK AVE #100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3657
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Country | US
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Telephone | 719-471-0727
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Fax | 719-471-2116
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Provider Business Mailing Address
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Address Line | 559 E. PIKES PEAK AVE #100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3657
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Country | US
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Telephone | 719-471-0727
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Fax | 719-471-2116
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY O. HALL
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Credential | M.D.
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Telephone | 719-471-0727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 29593
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License Number State | CO
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