Healthcare Provider Details

I. General information

NPI: 1144036195
Provider Name (Legal Business Name): OWN PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 W 38TH AVE
DENVER CO
80212-2025
US

IV. Provider business mailing address

8502 YANK CT
ARVADA CO
80005-5110
US

V. Phone/Fax

Practice location:
  • Phone: 208-201-5345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNIE CLOSE
Title or Position: OWNER
Credential: MSOT, OTR/L
Phone: 208-201-5345