Basic Information
Provider Information
NPI: 1689777674
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAY
FirstName: TERI
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3574
Address2:  
City: BRECKENRIDGE
State: CO
PostalCode: 804243574
CountryCode: US
TelephoneNumber: 9706680888
FaxNumber:  
Practice Location
Address1: 360 PEAK ONE DR
Address2: STE 190
City: FRISCO
State: CO
PostalCode: 80443
CountryCode: US
TelephoneNumber: 9706680888
FaxNumber: 9706680227
Other Information
ProviderEnumerationDate: 09/06/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X5665COY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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