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General NPI Number Information
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NPI Number | 1841625902
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Entity Type | Organization
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Legal Business Name | SPINAL CORD INJURY RECOVERY PROJECT
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 866 E 78TH AVE
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City | DENVER
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State | CO
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Zip | 80229-5934
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Country | US
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Telephone | 303-286-0918
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Fax |
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Provider Business Mailing Address
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Address Line | 866 E 78TH AVE
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City | DENVER
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State | CO
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Zip | 80229-5934
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. AMANDA NICHOLE WILSON
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Credential |
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Telephone | 303-286-0918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 47329
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License Number State | CO
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