Provider Demographics
NPI:1699924506
Name:BLUE SKY PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:BLUE SKY PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:303-917-8952
Mailing Address - Street 1:155 S MADISON ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3011
Mailing Address - Country:US
Mailing Address - Phone:303-917-8952
Mailing Address - Fax:
Practice Address - Street 1:155 S MADISON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3011
Practice Address - Country:US
Practice Address - Phone:303-917-8952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy