Provider Demographics
NPI:1316286164
Name:ONE80 PHYSICAL THERAPY CENTENNIAL
Entity type:Organization
Organization Name:ONE80 PHYSICAL THERAPY CENTENNIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:
Authorized Official - Last Name:POLKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:970-593-9300
Mailing Address - Street 1:7275 S REVERE PKWY
Mailing Address - Street 2:#804
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6783
Mailing Address - Country:US
Mailing Address - Phone:720-502-7023
Mailing Address - Fax:
Practice Address - Street 1:7275 S REVERE PKWY
Practice Address - Street 2:#804
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6783
Practice Address - Country:US
Practice Address - Phone:720-502-7023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE80 PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty