Provider Demographics
NPI:1306455845
Name:ASCENSION PHYSICAL THERAPY, FITNESS AND WELLNESS LLC
Entity type:Organization
Organization Name:ASCENSION PHYSICAL THERAPY, FITNESS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FORESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-475-5102
Mailing Address - Street 1:567 S GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1416
Mailing Address - Country:US
Mailing Address - Phone:303-475-5102
Mailing Address - Fax:
Practice Address - Street 1:600 S CHERRY ST STE 230
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1714
Practice Address - Country:US
Practice Address - Phone:303-475-5102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy