Provider Demographics
NPI:1588784417
Name:BAYFIELD PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:BAYFIELD PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE'
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNOW
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:970-884-2423
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-0465
Mailing Address - Country:US
Mailing Address - Phone:970-884-2423
Mailing Address - Fax:970-884-7473
Practice Address - Street 1:182 W NORTH STREET
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122
Practice Address - Country:US
Practice Address - Phone:970-884-2423
Practice Address - Fax:970-884-7473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07-0061261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COBA27499OtherCOLORADO BCBS GROUP #
COBA27499OtherCOLORADO BCBS GROUP #