Healthcare Provider Details

I. General information

NPI: 1043700594
Provider Name (Legal Business Name): COLORADO SPORTS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 EMPIRE RD STE 201
LAFAYETTE CO
80026-2606
US

IV. Provider business mailing address

390 EMPIRE RD STE 201
LAFAYETTE CO
80026-2606
US

V. Phone/Fax

Practice location:
  • Phone: 410-279-0479
  • Fax:
Mailing address:
  • Phone: 720-216-5128
  • Fax: 720-316-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number0015257
License Number StateCO

VIII. Authorized Official

Name: CATHERINE SCHNELL CAMPBELL
Title or Position: OWNER
Credential: PT, DPT, SCS
Phone: 720-216-5128