Healthcare Provider Details

I. General information

NPI: 1306067830
Provider Name (Legal Business Name): PRO PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 BASELINE RD SUITE D 107
BOULDER CO
80303-2699
US

IV. Provider business mailing address

4800 BASELINE RD SUITE D 107
BOULDER CO
80303-2699
US

V. Phone/Fax

Practice location:
  • Phone: 303-499-6818
  • Fax: 303-499-0853
Mailing address:
  • Phone: 303-499-6818
  • Fax: 303-499-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier96226838
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 2
IdentifierC810645
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerMEDICARE PIN

VIII. Authorized Official

Name: BARBARA ANN TSCHOEPE
Title or Position: PRESIDENT
Credential: PT, PHD
Phone: 303-499-6818