Healthcare Provider Details

I. General information

NPI: 1225715345
Provider Name (Legal Business Name): TRANSFORMATIVE PAIN CARE AND PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 VALLEY VIEW DR STE 309
DELTA CO
81416-3130
US

IV. Provider business mailing address

546 APRICOT LN
DELTA CO
81416-3067
US

V. Phone/Fax

Practice location:
  • Phone: 970-639-1948
  • Fax: 970-808-2006
Mailing address:
  • Phone: 970-639-1948
  • Fax: 970-808-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN R JOHNSON
Title or Position: PHYSICAL THERAPIST/CEO
Credential:
Phone: 970-208-4890