=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942557319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA SUE VAN HOOK PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2012
-----------------------------------------------------
Last Update Date | 08/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8540 SCARBOROUGH DR SUITE 200
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-7502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 171-963-0750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1102 E BOULDER ST
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80903-3112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 180-358-6592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 12523
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------