MEDICARE: STEPHANIE CAROLE PASCOE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	10392	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10392	OTHER	CO	STATE OF COLORADO
2	11055-27	OTHER	WI	PHYSICAL THERAPIST

General Provider Information

NPI Number	:	1992968671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CAROLE PASCOE

Provider Business Mailing Address
First Line	:	4640 KASHMIRE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7614
Country	:	US
Telephone Number	:	719-321-9837
Fax Number	:

Provider Business Practice Location Address
First Line	:	5387 MANHATTAN CIR
Second Line	:	SUITE 100
City	:	BOULDER
State	:	CO
Zip	:	80303-4284
Country	:	US
Telephone Number	:	303-543-7676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	03/08/2011

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