Provider Demographics
NPI:1992876148
Name:PHYSICAL THERAPY CENTER, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-776-0333
Mailing Address - Street 1:1330 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3218
Mailing Address - Country:US
Mailing Address - Phone:303-776-0333
Mailing Address - Fax:303-776-0107
Practice Address - Street 1:1330 SUNSET ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3218
Practice Address - Country:US
Practice Address - Phone:303-776-0333
Practice Address - Fax:303-776-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO193624OtherDEPT. OF LABOR - WASHINGT
CO4915543OtherCIGNA PIN#
COPH654911OtherANTHEM BLUE CROSS/SHIELD
CO193624OtherDEPT. OF LABOR - WASHINGT