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General NPI Number Information
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NPI Number | 1942969878
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Entity Type | Organization
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Legal Business Name | TELLURIDE PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 126 W. COLORADO AVE
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City | TELLURIDE
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State | CO
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Zip | 81435
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Country | US
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Telephone | 970-729-0974
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Fax |
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Provider Business Mailing Address
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Address Line | 305 SOCIETY DR APT C2
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City | TELLURIDE
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State | CO
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Zip | 81435-8935
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Country | US
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Telephone | 970-729-0874
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CANDICE GOOD
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Credential | PT
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Telephone | 970-729-0874
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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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