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General NPI Number Information
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NPI Number | 1770256091
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Entity Type | Organization
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Legal Business Name | ENHANCED RECOVERY AND WELLNESS LLC
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 6364 MARILEE WAY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-8356
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Country | US
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Telephone | 719-203-2795
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Fax | 719-239-3785
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Provider Business Mailing Address
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Address Line | 6364 MARILEE WAY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-8356
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Country | US
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Telephone | 719-203-2795
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Fax | 719-239-3785
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Authorized Official
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Title or Position | OWNER
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Name | DR. REBECA SEGRAVES
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Credential | PT, DPT
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Telephone | 336-508-3881
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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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