Healthcare Provider Details

I. General information

NPI: 1548637069
Provider Name (Legal Business Name): PHENIX THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MEDICAL CENTER PT STE 180
COLORADO SPRINGS CO
80907-5798
US

IV. Provider business mailing address

1625 MEDICAL CENTER PT STE 180
COLORADO SPRINGS CO
80907-5798
US

V. Phone/Fax

Practice location:
  • Phone: 719-344-9497
  • Fax: 719-358-6042
Mailing address:
  • Phone: 719-344-9497
  • Fax: 719-358-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7832
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCO

VIII. Authorized Official

Name: LORNE MACDONALD
Title or Position: OWNER
Credential: DPT
Phone: 719-344-9497