Healthcare Provider Details

I. General information

NPI: 1295359776
Provider Name (Legal Business Name): CARBON CREEK PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W TOMICHI AVE
GUNNISON CO
81230-2713
US

IV. Provider business mailing address

PO BOX 335
GUNNISON CO
81230-0335
US

V. Phone/Fax

Practice location:
  • Phone: 970-901-7684
  • Fax:
Mailing address:
  • Phone: 209-327-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ROBERT BAUMGARTEN
Title or Position: OWNER
Credential:
Phone: 209-327-8872