Healthcare Provider Details

I. General information

NPI: 1104573666
Provider Name (Legal Business Name): PHYSIO PRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 WASHINGTON AVE UNIT B
GOLDEN CO
80403-1889
US

IV. Provider business mailing address

393 WASHINGTON AVE UNIT B
GOLDEN CO
80403-1889
US

V. Phone/Fax

Practice location:
  • Phone: 720-307-7707
  • Fax: 720-307-7702
Mailing address:
  • Phone: 720-307-7707
  • Fax: 720-307-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NATHAN J LILLEY
Title or Position: OWNER
Credential: PT
Phone: 303-370-2670