Provider Demographics
NPI:1912943564
Name:PHYSICOR REHABILITATION LLC
Entity type:Organization
Organization Name:PHYSICOR REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDESSARI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-884-3118
Mailing Address - Street 1:PO BOX 40189
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-0189
Mailing Address - Country:US
Mailing Address - Phone:303-884-3118
Mailing Address - Fax:
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4046
Practice Address - Country:US
Practice Address - Phone:303-884-3118
Practice Address - Fax:303-862-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805037Medicare PIN