Provider Demographics
NPI:1316129653
Name:MY PHYSICAL THERAPIST INC
Entity type:Organization
Organization Name:MY PHYSICAL THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-227-0400
Mailing Address - Street 1:4820 MOUNTAIN GOLD RUN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8757
Mailing Address - Country:US
Mailing Address - Phone:303-451-5539
Mailing Address - Fax:303-227-0402
Practice Address - Street 1:2152 E 88TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-5023
Practice Address - Country:US
Practice Address - Phone:303-227-0400
Practice Address - Fax:303-227-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC493708Medicare PIN