Healthcare Provider Details

I. General information

NPI: 1265550313
Provider Name (Legal Business Name): FOOTHILLS PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ENGLEWOOD PKWY SUITE 108
ENGLEWOOD CO
80110-2305
US

IV. Provider business mailing address

901 ENGLEWOOD PKWY SUITE 108
ENGLEWOOD CO
80110-2305
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-3085
  • Fax: 303-761-4066
Mailing address:
  • Phone: 303-761-3085
  • Fax: 303-761-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number4489
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4489
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4489
License Number StateCO

VIII. Authorized Official

Name: MS. BRONNY BROOKS
Title or Position: MANAGER
Credential: P.T.
Phone: 303-761-3085