Provider Demographics
NPI:1538238399
Name:CORTEZ PHYSICAL THERAPY
Entity type:Organization
Organization Name:CORTEZ PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULLIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-533-7649
Mailing Address - Street 1:121 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-9059
Mailing Address - Country:US
Mailing Address - Phone:970-533-7649
Mailing Address - Fax:970-533-9089
Practice Address - Street 1:121 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328-9059
Practice Address - Country:US
Practice Address - Phone:970-533-7649
Practice Address - Fax:970-533-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1930 PHYSICL THERAP247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66021081Medicaid
CO66021081Medicaid