Provider Demographics
NPI:1962675959
Name:SCHANK, DAVID R (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:SCHANK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:575 RIVERGATE
Mailing Address - Street 2:STE 208
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7487
Mailing Address - Country:US
Mailing Address - Phone:970-259-2547
Mailing Address - Fax:970-259-9653
Practice Address - Street 1:575 RIVERGATE
Practice Address - Street 2:STE 208
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-259-2547
Practice Address - Fax:970-259-9653
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
4069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82552070Medicaid
COCP1503Medicare UPIN