Provider Demographics
NPI:1063646081
Name:TAIL WIND THERAPIES PC
Entity type:Organization
Organization Name:TAIL WIND THERAPIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-245-0511
Mailing Address - Street 1:1000 N 9TH ST STE 35
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3153
Mailing Address - Country:US
Mailing Address - Phone:970-245-0511
Mailing Address - Fax:970-245-1025
Practice Address - Street 1:1000 N 9TH ST STE 35
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3153
Practice Address - Country:US
Practice Address - Phone:970-245-0511
Practice Address - Fax:970-245-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty