Provider Demographics
NPI:1154797157
Name:ME PHYSICAL THERAPY
Entity type:Organization
Organization Name:ME PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISTAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-221-1569
Mailing Address - Street 1:6240 S MAIN ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5376
Mailing Address - Country:US
Mailing Address - Phone:303-627-5735
Mailing Address - Fax:303-627-5734
Practice Address - Street 1:6240 S MAIN ST
Practice Address - Street 2:SUITE 230
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5376
Practice Address - Country:US
Practice Address - Phone:303-627-5735
Practice Address - Fax:303-627-5734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN VIEW PAIN CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO6341111N00000X
COPTL.0013556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherPHYSICAL THERRAPY CLINIC