Provider Demographics
NPI:1285771014
Name:PERSONAL REHABILITATION CENTER, PC
Entity type:Organization
Organization Name:PERSONAL REHABILITATION CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-963-6600
Mailing Address - Street 1:1378 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1850
Mailing Address - Country:US
Mailing Address - Phone:970-963-6600
Mailing Address - Fax:970-963-4288
Practice Address - Street 1:1378 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1850
Practice Address - Country:US
Practice Address - Phone:970-963-6600
Practice Address - Fax:970-963-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherTAX ID #