Active NPI
Teresa Southard, PT
- Physical Therapist
- Boulder, CO
National Provider Identifier
1174732689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6064
- Practice address
- 1100 Balsam Ave
Boulder, CO 80304-3404 - Phone
- (303) 441-0526
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6064 | CO | Primary |
Addresses
Primary practice location
1100 Balsam Ave
Boulder, CO 80304-3404
Mailing address
370 Inca Pkwy
Boulder, CO 80303-3518
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6064 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174732689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "370 INCA PKWY",
"city": "BOULDER",
"state": "CO",
"postal_code": "803033518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 BALSAM AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043404",
"telephone_number": "303-441-0526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHARD",
"first_name": "TERESA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "6064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.