Organization
CANON CITY PHYSIOTHERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL WAYNE PASCHALL P.T. (OWNER)
(719) 269-1142
Entity
Organization
Contact information
Practice address
1107 MAIN ST, CANON CITY, CO 81212-3413
(719) 269-1142
(719) 269-1413
Mailing address
1107 MAIN ST, CANON CITY, CO 81212-3413
(719) 269-1142
(719) 269-1413
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5795
CO
225100000X
Physical Therapist
6141
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650021141
RAILROAD MEDICARE
CO
05
—
68131364
—
CO
Enumeration date
01/25/2007
Last updated
07/13/2022
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