Healthcare Provider Details

I. General information

NPI: 1932996980
Provider Name (Legal Business Name): COLORADO PATRICK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8085 S CHESTER ST # 204
CENTENNIAL CO
80112-3543
US

IV. Provider business mailing address

1090 S WADSWORTH BLVD STE C
LAKEWOOD CO
80226-4350
US

V. Phone/Fax

Practice location:
  • Phone: 850-591-1158
  • Fax:
Mailing address:
  • Phone: 850-591-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES PATRICK
Title or Position: OWNER / PHYSICAL THERAPIST
Credential: PT
Phone: 850-591-1158