Provider Demographics
NPI:1992914428
Name:RICHIE, MAURA LEE JANE (DPT)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:LEE JANE
Last Name:RICHIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 BOARDWALK DR
Mailing Address - Street 2:G-31
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7309
Mailing Address - Country:US
Mailing Address - Phone:904-254-4000
Mailing Address - Fax:
Practice Address - Street 1:4800 W 25TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3734
Practice Address - Country:US
Practice Address - Phone:907-330-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-9582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist