1306067830 NPI number — PRO PHYSICAL THERAPY, PC

Table of content: (NPI 1306067830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306067830 NPI number — PRO PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO PHYSICAL THERAPY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306067830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 BASELINE RD
Provider Second Line Business Mailing Address:
SUITE D 107
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80303-2699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-499-6818
Provider Business Mailing Address Fax Number:
303-499-0853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 BASELINE RD
Provider Second Line Business Practice Location Address:
SUITE D 107
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80303-2699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-499-6818
Provider Business Practice Location Address Fax Number:
303-499-0853
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TSCHOEPE
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-499-6818

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 96226838 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: C810645 . This is a "MEDICARE PIN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com