Healthcare Provider Details

I. General information

NPI: 1629487947
Provider Name (Legal Business Name): AMARYLLIS THERAPY NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 11/12/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 HARLAN ST STE 200
DENVER CO
80212-7417
US

IV. Provider business mailing address

4704 HARLAN ST STE 200
DENVER CO
80212-7417
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-0852
  • Fax: 303-477-9223
Mailing address:
  • Phone: 303-433-0852
  • Fax: 303-477-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA ANN CLARK
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 303-433-0852