Canon City Physiotherapy Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5795 Issued in CO

Legal business name

CANON CITY PHYSIOTHERAPY INC

Practice address

1107 Main St
Canon City, CO 81212-3413

Phone

(719) 269-1142

Fax

(719) 269-1413

NPI assigned

Jan 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Wayne Paschall, P.T.NPI 1225187768

Title

Owner

Phone

(719) 269-1142

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Wayne Paschall, P.T.

  • Physical Therapist
  • Canon City, CO
  • NPI 1225187768
  Medicare reassignment Care Compare group NPD Authorized official
• Debra Paschall, PT

  • Physical Therapist
  • Canon City, CO
  • NPI 1619515897
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1154477065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 MAIN ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123413",
            "telephone_number": "719-269-1142",
            "fax_number": "719-269-1413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 MAIN ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123413",
            "telephone_number": "719-269-1142",
            "fax_number": "719-269-1413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANON CITY PHYSIOTHERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "PASCHALL",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-269-1142",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "5795",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "6141",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650021141",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68131364",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Canon City Counseling & Psychotherapy Services
• Canon City Counseling, Inc
• Canon City Dental & Implants, PC
• Canon City Nursing and Rehab Center, LLC
• Canon City OBGYN PC
• Canon Kids Dental & Braces, PC
• Canon Professional Wellness Clinic LLC
• Canon Professional, L.L.C.
• Tiffany Diane Cardinal
• Laurie Carle, PT

• Physical Therapist in Canon City, CO
• Providers in Canon City, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.