Provider Demographics
NPI:1336591940
Name:ADVENTURE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ADVENTURE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-251-5098
Mailing Address - Street 1:PO BOX 2686
Mailing Address - Street 2:311 5TH STREET
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-2686
Mailing Address - Country:US
Mailing Address - Phone:970-251-5098
Mailing Address - Fax:970-251-5090
Practice Address - Street 1:140 BLACKSTOCK DR UNIT A
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-8001
Practice Address - Country:US
Practice Address - Phone:970-251-5098
Practice Address - Fax:970-251-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty