Healthcare Provider Details

I. General information

NPI: 1619560794
Provider Name (Legal Business Name): ANEWU PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 BASELINE RD STE 100
BOULDER CO
80303-2318
US

IV. Provider business mailing address

209 SEMINOLE DR
BOULDER CO
80303-4228
US

V. Phone/Fax

Practice location:
  • Phone: 970-480-7118
  • Fax:
Mailing address:
  • Phone: 408-307-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. AMANDA E GOTSCHALL
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 408-307-1199