Provider Demographics
NPI:1104402247
Name:MONUMENT PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MONUMENT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-325-6026
Mailing Address - Street 1:321 ROOD AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2420
Mailing Address - Country:US
Mailing Address - Phone:970-325-6026
Mailing Address - Fax:
Practice Address - Street 1:58128 HIGHWAY 330 BLDG B
Practice Address - Street 2:
Practice Address - City:COLLBRAN
Practice Address - State:CO
Practice Address - Zip Code:81624-9502
Practice Address - Country:US
Practice Address - Phone:970-242-0111
Practice Address - Fax:970-263-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy