Healthcare Provider Details

I. General information

NPI: 1902207863
Provider Name (Legal Business Name): THERAPYDIA COLORADO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 15TH ST SUITE 100
BOULDER CO
80302-6341
US

IV. Provider business mailing address

18 E BLITHEDALE AVE SUITE 21
MILL VALLEY CA
94941-1908
US

V. Phone/Fax

Practice location:
  • Phone: 760-822-8274
  • Fax:
Mailing address:
  • Phone: 415-389-8677
  • 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: TASHA DEMKIW
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 760-822-8274