MEDICARE: MVP PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	10125	CO

General Provider Information

NPI Number	:	1326473141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVP PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	13635 E 104TH AVE
Second Line	:	STE 700
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-8409
Country	:	US
Telephone Number	:	720-506-5340
Fax Number	:

Provider Business Practice Location Address
First Line	:	13659 E 104TH AVE UNIT 300
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9402
Country	:	US
Telephone Number	:	720-506-5340
Fax Number	:	720-506-5343

Authorized Official
Title or Position	:	OWNER / OPERATOR
Name	:	RONNIE SHANE ESKEW
Credential	:	MSPT
Telephone Number	:	303-332-1761

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	12/22/2020

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