is a Pediatrics in Evergreen, Colorado. practices all healthcare services and medical treatments related to Pediatrics. The NPI Number for is 1952510208. The last update date is .
's current location address is 29196 Histead Dr, Evergreen, Colorado. You can contact this provider via phone number 3033490274. The mailing address for is 29196 Histead Dr, Evergreen, Colorado. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 29196 Histead Dr, Evergreen, Colorado |
| Phone Number | 3033490274 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1952510208 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 29196 Histead Dr |
|---|---|
| City | Evergreen |
| State | Colorado (CO) |
| Post Code | 804398451 |
| Phone Number | 3033490274 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Pediatrics |
|---|---|
| Taxonomy | 2251P0200X |
| Licence No | PT8471 |
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Definition: A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Pediatric Physical Therapy, who has demonstrated specialized knowledge and skill in anatomy, histology, including embryonic development, |
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