Basic Information
| Provider Information | |||||||||
| NPI: | 1548370067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STASHICK | ||||||||
| FirstName: | TERRI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13 | ||||||||
| Address2: | |||||||||
| City: | EDWARDS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703068609 | ||||||||
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| Practice Location | |||||||||
| Address1: | 358 BLUE RIVER PARKWAY | ||||||||
| Address2: | SUITE G | ||||||||
| City: | SILVERTHORNE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703068609 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 10/26/2012 | ||||||||
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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 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 6920 | 01 | CO | LICENSE# | OTHER |