Healthcare Provider Details

I. General information

NPI: 1821000415
Provider Name (Legal Business Name): ACTIVE MOTION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3865 CHERRY CREEK NORTH DR LL70
DENVER CO
80209-3803
US

IV. Provider business mailing address

3865 CHERRY CREEK NORTH DR LL70
DENVER CO
80209-3803
US

V. Phone/Fax

Practice location:
  • Phone: 303-394-3356
  • Fax: 303-394-3359
Mailing address:
  • Phone: 303-394-3356
  • Fax: 303-394-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3349
License Number StateCO

VIII. Authorized Official

Name: MR. DERICK LEVY
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential: PT
Phone: 303-394-3356