Provider Demographics
NPI:1316083348
Name:REGISTERED PHYSICAL THERAPY ASSOCIATES, PC
Entity type:Organization
Organization Name:REGISTERED PHYSICAL THERAPY ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-442-0621
Mailing Address - Street 1:PO BOX 271150
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5021
Mailing Address - Country:US
Mailing Address - Phone:303-442-0621
Mailing Address - Fax:303-442-8218
Practice Address - Street 1:5377 MANHATTAN CIR
Practice Address - Street 2:202
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4333
Practice Address - Country:US
Practice Address - Phone:303-442-0621
Practice Address - Fax:303-442-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP2203Medicare UPIN