Provider Demographics
NPI:1124101795
Name:SOUTHPARK PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:SOUTHPARK PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-730-7117
Mailing Address - Street 1:8151 SOUTHPARK LN
Mailing Address - Street 2:#100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4502
Mailing Address - Country:US
Mailing Address - Phone:303-730-7117
Mailing Address - Fax:303-730-7119
Practice Address - Street 1:8151 SOUTHPARK LN
Practice Address - Street 2:#100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4502
Practice Address - Country:US
Practice Address - Phone:303-730-7117
Practice Address - Fax:303-730-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C810630OtherMEDICARE PTAN
COC553178Medicare PIN