Provider Demographics
NPI:1699958306
Name:PELVIC THERAPY SPECIALISTS, PC
Entity type:Organization
Organization Name:PELVIC THERAPY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SHEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-601-7495
Mailing Address - Street 1:4770 BASELINE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2667
Mailing Address - Country:US
Mailing Address - Phone:303-601-7495
Mailing Address - Fax:
Practice Address - Street 1:5377 MANHATTAN CIR
Practice Address - Street 2:SUITE #104
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4333
Practice Address - Country:US
Practice Address - Phone:303-601-7495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 261QP2000X
CO8348261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811315Medicare PIN