Healthcare Provider Details

I. General information

NPI: 1164087169
Provider Name (Legal Business Name): CLE PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 EDWARDS VILLAGE BLVD UNIT 204
EDWARDS CO
81632-7804
US

IV. Provider business mailing address

PO BOX 3295
AVON CO
81620-3295
US

V. Phone/Fax

Practice location:
  • Phone: 404-593-5104
  • Fax:
Mailing address:
  • Phone: 404-593-5104
  • Fax: 970-965-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARRIE LEE ECKENHOFF
Title or Position: OWNER
Credential:
Phone: 404-593-5104