Healthcare Provider Details

I. General information

NPI: 1881776748
Provider Name (Legal Business Name): MOUNTAIN VALLEY PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S DEXTER ST
DENVER CO
80246-2605
US

IV. Provider business mailing address

910 S DEXTER ST
DENVER CO
80246-2605
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-6878
  • Fax: 303-757-6859
Mailing address:
  • Phone: 303-758-6878
  • Fax: 303-757-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7169
License Number StateCO

VIII. Authorized Official

Name: JENNIFER BOLD ELLIS
Title or Position: PRESIDENT
Credential: MPT
Phone: 303-888-2993