Provider Demographics
NPI:1588779946
Name:VANDERBIE-PACE, DARCY (MS PT)
Entity type:Individual
Prefix:MRS
First Name:DARCY
Middle Name:
Last Name:VANDERBIE-PACE
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 30TH STREET
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1026
Mailing Address - Country:US
Mailing Address - Phone:303-546-9201
Mailing Address - Fax:303-545-5080
Practice Address - Street 1:1800 30TH STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1026
Practice Address - Country:US
Practice Address - Phone:303-546-9201
Practice Address - Fax:303-545-5080
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
471008Medicare ID - Type Unspecified