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General NPI Number Information
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NPI Number | 1750984316
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Entity Type | Organization
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Legal Business Name | BACKCOUNTRY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 2660 VICKERS DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1941
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Country | US
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Telephone | 719-285-9670
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Fax |
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Provider Business Mailing Address
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Address Line | 332 N MEADE AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5640
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Country | US
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Telephone | 217-371-3008
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT RUNYON
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Credential | PT, DPT
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Telephone | 719-285-9670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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