Provider Demographics
NPI:1306890702
Name:DENVER PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:DENVER PHYSICAL THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:EDEN
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-628-0871
Mailing Address - Street 1:7310 S ALTON WAY
Mailing Address - Street 2:STE 6L
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2334
Mailing Address - Country:US
Mailing Address - Phone:303-790-4495
Mailing Address - Fax:720-488-1988
Practice Address - Street 1:2260 S XANADU WAY
Practice Address - Street 2:STE 245
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1373
Practice Address - Country:US
Practice Address - Phone:303-755-8826
Practice Address - Fax:303-755-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-02-04
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
CODEN0503OtherANTHEM BLUE CROSS/SHIELD
CO=========80204OtherTRICARE
CODEN0503OtherANTHEM BLUE CROSS/SHIELD