Healthcare Provider Details

I. General information

NPI: 1013532548
Provider Name (Legal Business Name): DIRECT ACCESS AT HOME THERAPY-CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7887 EAST BELLEVIEW AVE
DENVER CO
80111-6015
US

IV. Provider business mailing address

132 PEARLCROFT RD
CHERRY HILL NJ
08034-3334
US

V. Phone/Fax

Practice location:
  • Phone: 609-509-2388
  • Fax:
Mailing address:
  • Phone: 609-509-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD AUSTIN DUUS
Title or Position: CFO
Credential: CPA
Phone: 609-509-2388