Provider Demographics
NPI:1992342901
Name:SOL SHINE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SOL SHINE PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-434-1180
Mailing Address - Street 1:13900 LAKE SONG LN UNIT M4
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-6556
Mailing Address - Country:US
Mailing Address - Phone:720-434-1180
Mailing Address - Fax:
Practice Address - Street 1:13900 LAKE SONG LN UNIT M4
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-6556
Practice Address - Country:US
Practice Address - Phone:720-434-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty