Provider Demographics
NPI:1124212352
Name:ROCKY MOUNTAIN PHYSICAL THERAPY & SPORTS INJURY CENTER, INC.
Entity type:Organization
Organization Name:ROCKY MOUNTAIN PHYSICAL THERAPY & SPORTS INJURY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAME
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTURINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-731-3303
Mailing Address - Street 1:117 NAVAJO TRAIL DRIVE SUITE T
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147
Mailing Address - Country:US
Mailing Address - Phone:970-731-3303
Mailing Address - Fax:970-731-2201
Practice Address - Street 1:117 NAVAJO TRAIL DRIVE SUITE T
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-731-3303
Practice Address - Fax:970-731-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59157267Medicaid
COC800006Medicare PIN