Healthcare Provider Details

I. General information

NPI: 1306924659
Provider Name (Legal Business Name): THE CENTER FOR PHYSICAL WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S JACKSON ST SUITE 820
DENVER CO
80210-3801
US

IV. Provider business mailing address

1776 S JACKSON ST STE 820
DENVER CO
80210-3807
US

V. Phone/Fax

Practice location:
  • Phone: 303-300-6842
  • Fax: 303-758-1260
Mailing address:
  • Phone: 303-300-6842
  • Fax: 303-758-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4164
License Number StateCO

VIII. Authorized Official

Name: MRS. STACY ANN TUCKWELL
Title or Position: OWNER
Credential: MPT
Phone: 303-300-6842