Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 0014414 | CO |
NPI | 1013475896 |
---|---|
Provider Name | Chase Baird Hughes |
First Address | Colorado Springs, CO 80918-1744 |
Second Address | Colorado Springs, CO 80918-1744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2019 |
Last Update Date | 11/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
UCL654M96436 | BLUE CROSS BLUE SHIELD (01) | CO |