Provider Demographics
NPI:1962581876
Name:MOUNTAINLAND THERAPY & ASSOCIATES PC
Entity type:Organization
Organization Name:MOUNTAINLAND THERAPY & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SIEGFRIED
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-887-2733
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446
Mailing Address - Country:US
Mailing Address - Phone:970-887-2733
Mailing Address - Fax:970-887-0133
Practice Address - Street 1:17 TEN MILE DR, UNIT D
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-887-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C536788Medicare ID - Type UnspecifiedGROUP #