Provider Demographics
NPI:1992968671
Name:PASCOE, STEPHANIE CAROLE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CAROLE
Last Name:PASCOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:CAROLE
Other - Last Name:NEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4640 KASHMIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7614
Mailing Address - Country:US
Mailing Address - Phone:719-321-9837
Mailing Address - Fax:
Practice Address - Street 1:5387 MANHATTAN CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4284
Practice Address - Country:US
Practice Address - Phone:303-543-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10392OtherSTATE OF COLORADO
WI11055-27OtherPHYSICAL THERAPIST