Basic Information
| Provider Information | |||||||||
| NPI: | 1023007895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCREYNOLDS | ||||||||
| FirstName: | ROSE MARIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4567 E 9TH AVE | ||||||||
| Address2: | ATTN ROSE INPATIENT REHAB | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033202818 | ||||||||
| FaxNumber: | 3033207117 | ||||||||
| Practice Location | |||||||||
| Address1: | 4567 E 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033202818 | ||||||||
| FaxNumber: | 3033207117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 938 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 18824064 | 05 | CO | MEDICAID | 066615 | 01 | CO | MEDICARE GROUP # | OTHER | 86723251 | 01 | CO | MEDICAID PRACTICE GROUP # | OTHER |