MEDICARE: PHOENIX 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

General Provider Information

NPI Number	:	1811886732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2452 SILVERTON ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-6209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2452 SILVERTON ST
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-6209
Country	:	US
Telephone Number	:	770-377-4380
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	TYLER CARL SHANDRA
Credential	:	DPT
Telephone Number	:	714-743-7311

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	04/14/2026

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