Healthcare Provider Details

I. General information

NPI: 1588784417
Provider Name (Legal Business Name): BAYFIELD PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 W NORTH STREET
BAYFIELD CO
81122
US

IV. Provider business mailing address

PO BOX 465
BAYFIELD CO
81122-0465
US

V. Phone/Fax

Practice location:
  • Phone: 970-884-2423
  • Fax: 970-884-7473
Mailing address:
  • Phone: 970-884-2423
  • Fax: 970-884-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number07-0061
License Number StateCO

VIII. Authorized Official

Name: MR. ANDRE' SARNOW
Title or Position: OWNER
Credential: RPT
Phone: 970-884-2423