Provider Demographics
NPI:1386781458
Name:FAIRPLAY PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:FAIRPLAY PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:719-836-1833
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-1087
Mailing Address - Country:US
Mailing Address - Phone:719-836-1833
Mailing Address - Fax:719-836-3346
Practice Address - Street 1:540 FRONT ST
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440-1087
Practice Address - Country:US
Practice Address - Phone:719-836-1833
Practice Address - Fax:719-836-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC528568Medicare ID - Type Unspecified