Healthcare Provider Details

I. General information

NPI: 1467966432
Provider Name (Legal Business Name): THERAPY WORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 GRANT AVE
COLORADO SPRINGS CO
80909-2417
US

IV. Provider business mailing address

1834 GRANT AVE
COLORADO SPRINGS CO
80909-2417
US

V. Phone/Fax

Practice location:
  • Phone: 516-578-8967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0011130
License Number StateCO

VIII. Authorized Official

Name: MATTHEW KOLTUN
Title or Position: OWNER
Credential: PT
Phone: 516-578-8967