Healthcare Provider Details

I. General information

NPI: 1184155889
Provider Name (Legal Business Name): SPROUT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 S BIRCH ST
DENVER CO
80222-3609
US

IV. Provider business mailing address

1440 S BIRCH ST
DENVER CO
80222-3609
US

V. Phone/Fax

Practice location:
  • Phone: 615-351-6246
  • Fax:
Mailing address:
  • Phone: 615-351-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0009761
License Number StateCO

VIII. Authorized Official

Name: LAURA TOWBIN
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 615-351-6246