Provider Demographics
NPI:1902979321
Name:SCHUBARTH, PAMELA KAY (RPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:SCHUBARTH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2930
Mailing Address - Country:US
Mailing Address - Phone:970-581-5739
Mailing Address - Fax:
Practice Address - Street 1:1701 WATERFORD LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2930
Practice Address - Country:US
Practice Address - Phone:970-581-5739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24962251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73782831Medicaid