Robert E Hastings III

Individual provider Active NPI Physical Therapist · Mancos, CO

NPI 1114275286 · NPPES record last updated Aug 21, 2012

Key facts

NPI
1114275286
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapist 225100000X
License
10736 (CO)
Practice address
211 E 3Rd Ave
Mancos, CO 81328-9079
Phone
(970) 533-9031
NPI assigned
Aug 21, 2012
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
10736COMDPhysical Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10736 CO Yes

Addresses

Primary practice location

211 E 3Rd Ave
Mancos, CO 81328-9079

Mailing address

41020 Road 38
Dolores, CO 81323-9512
Phone (970) 882-2347

Other providers in Mancos, CO

All providers in Mancos, CO · Physical Therapist in Colorado

Sources for this page

Verify at the official NPI Registry.