Provider Demographics
NPI:1104573666
Name:PHYSIO PRO, INC.
Entity type:Organization
Organization Name:PHYSIO PRO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-370-2670
Mailing Address - Street 1:393 WASHINGTON AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1889
Mailing Address - Country:US
Mailing Address - Phone:720-307-7707
Mailing Address - Fax:720-307-7702
Practice Address - Street 1:393 WASHINGTON AVE UNIT B
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1889
Practice Address - Country:US
Practice Address - Phone:720-307-7707
Practice Address - Fax:720-307-7702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSIO PRO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-04
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty