Active NPI
Diane M Ernewein, PT
- Physical Therapist
- Pueblo, CO
National Provider Identifier
1265611354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- CO 2899
- Practice address
- 4112 Outlook Blvd Ste 96
Pueblo, CO 81008-1667 - Phone
- (719) 562-6200
- NPI assigned
- Oct 25, 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 | CO 2899 | CO | Primary |
Addresses
Primary practice location
4112 Outlook Blvd Ste 96
Pueblo, CO 81008-1667
Mailing address
4112 Outlook Blvd Ste 96
Pueblo, CO 81008-1667
Phone (719) 562-6200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60929871 | Medicaid | CO |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO 2899 | CO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642118400000",
"number": "1265611354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4112 OUTLOOK BLVD STE 96",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081667",
"telephone_number": "719-562-6200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4112 OUTLOOK BLVD STE 96",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081667",
"telephone_number": "719-562-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERNEWEIN",
"first_name": "DIANE",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-25",
"last_updated": "2022-01-14",
"certification_date": "2022-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "CO 2899",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60929871",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.