Healthcare Provider Details

I. General information

NPI: 1013940808
Provider Name (Legal Business Name): ACTIVE SOLUTIONS PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 DARLEY AVE SUITE 8
BOULDER CO
80305-6557
US

IV. Provider business mailing address

4150 DARLEY AVE SUITE 8
BOULDER CO
80305-6557
US

V. Phone/Fax

Practice location:
  • Phone: 303-494-4100
  • Fax: 303-494-0212
Mailing address:
  • Phone: 303-494-4100
  • Fax: 303-494-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3608
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3897
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. OLAF DEROOS
Title or Position: PRESIDENT
Credential: PT
Phone: 303-494-4100