Healthcare Provider Details

I. General information

NPI: 1275290454
Provider Name (Legal Business Name): CPTN PRIME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 BRIGGS ST STE A-2
ERIE CO
80516-5022
US

IV. Provider business mailing address

3333 S WADSWORTH BLVD UNIT 212
LAKEWOOD CO
80227-5163
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-2405
  • Fax: 303-648-6602
Mailing address:
  • Phone: 303-757-7004
  • Fax: 303-757-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK ALLEN ENGLEMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: PT
Phone: 303-757-7004