Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTL.0014655 | CO |
N | 2251S0007X | Physical Therapist - Sports | PT 42849 | CA |
NPI | 1366810731 |
---|---|
Provider Name | Paige Hedstrom |
First Address | Fort Collins, CO 80524-3957 |
Second Address | Fort Collins, CO 80524-3957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2015 |
Last Update Date | 05/12/2018 |