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General NPI Number Information
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NPI Number | 1952510919
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Entity Type | Individual
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Provider Name | TERRY LEE EMBAUGH PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 1600 N GRAND AVE STE 500
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City | PUEBLO
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State | CO
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Zip | 81003-2757
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Country | US
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Telephone | 719-545-0663
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Fax | 719-595-7903
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Provider Business Mailing Address
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Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
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City | LOVELAND
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State | CO
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Zip | 80538-9071
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Country | US
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Telephone | 970-624-4127
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Fax | 970-490-4173
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0001838
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License Number State | CO
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