Basic Information
| Provider Information | |||||||||
| NPI: | 1285771014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERSONAL REHABILITATION CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1378 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816231850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709636600 | ||||||||
| FaxNumber: | 9709634288 | ||||||||
| Practice Location | |||||||||
| Address1: | 1378 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816231850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709636600 | ||||||||
| FaxNumber: | 9709634288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | WARREN | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | GRACE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9709636600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.