Healthcare Provider Details

I. General information

NPI: 1245149541
Provider Name (Legal Business Name): EXCEPTIONAL PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8475 LOST LAKE DR
FRANKTOWN CO
80116-9627
US

IV. Provider business mailing address

13671 SILVERTON DR
BROOMFIELD CO
80020-6034
US

V. Phone/Fax

Practice location:
  • Phone: 720-308-8818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHON TUCCIO
Title or Position: OWNER
Credential:
Phone: 720-308-8818