Healthcare Provider Details

I. General information

NPI: 1225624893
Provider Name (Legal Business Name): VILLAGE PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 S PERRY ST STE 200&220
CASTLE ROCK CO
80104-1900
US

IV. Provider business mailing address

823 S PERRY ST STE 200&220
CASTLE ROCK CO
80104-1900
US

V. Phone/Fax

Practice location:
  • Phone: 720-897-8395
  • Fax:
Mailing address:
  • Phone: 720-897-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARMEN PHILPOT
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 678-403-3568