Healthcare Provider Details

I. General information

NPI: 1336208818
Provider Name (Legal Business Name): PHYSIO PRO PHYSICAL THERAPY & CONDITIONING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STEELE ST
DENVER CO
80206-4479
US

IV. Provider business mailing address

311 STEELE ST
DENVER CO
80206-4479
US

V. Phone/Fax

Practice location:
  • Phone: 303-370-2670
  • Fax: 303-370-2690
Mailing address:
  • Phone: 303-370-2670
  • Fax: 303-370-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 4315
License Number StateCO

VIII. Authorized Official

Name: DEB ROTH
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 303-321-6600