Provider Demographics
NPI:1861873648
Name:STRIDES PEDIATRIC PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:STRIDES PEDIATRIC PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COBOS-TARIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:719-433-8380
Mailing Address - Street 1:13754 RIVERCREST CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3208
Mailing Address - Country:US
Mailing Address - Phone:719-433-8380
Mailing Address - Fax:719-495-6544
Practice Address - Street 1:13754 RIVERCREST CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3208
Practice Address - Country:US
Practice Address - Phone:719-433-8380
Practice Address - Fax:719-495-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8703251E00000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty