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Organization
PROACTIVE PROVIDER MANAGEMENT, LLC
Active
Organization
PROACTIVE PROVIDER MANAGEMENT, LLC
Active
Other names
ProActive Therapeutic Alliance
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT O'CONNOR (MEMBER)
(805) 266-4154
Entity
Organization
Contact information
Practice address
9320 GRAND CORDERA PKWY, STE 125, COLORADO SPRINGS, CO 80924-7003
(719) 535-2757
(719) 535-2767
Mailing address
9320 GRAND CORDERA PKWY, STE 125, COLORADO SPRINGS, CO 80924-7003
(719) 535-2757
(719) 535-2767
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
111N00000X
Chiropractor
—
—
133N00000X
Nutritionist
—
—
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
01/05/2016
Last updated
01/05/2016
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