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General NPI Number Information
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NPI Number | 1821411851
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Entity Type | Organization
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Legal Business Name | LEGACY REHABILITATION, INC.
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 1475 CHESHAM CIR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-8623
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Country | US
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Telephone | 719-229-2718
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Fax | 719-593-7084
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Provider Business Mailing Address
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Address Line | 1475 CHESHAM CIR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-8623
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Country | US
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Telephone | 719-229-2718
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Fax | 719-593-7084
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Authorized Official
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Title or Position | CEO
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Name | LEA HAY
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Credential | P.T.
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Telephone | 719-229-2718
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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 | PTL 0007803
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License Number State | CO
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