Healthcare Provider Details

I. General information

NPI: 1497784102
Provider Name (Legal Business Name): HIGH PLAINS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 GRANT AVE SUITE 100
LOVELAND CO
80538-8433
US

IV. Provider business mailing address

3880 GRANT AVE SUITE 100
LOVELAND CO
80538-8433
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-7780
  • Fax: 970-663-7781
Mailing address:
  • Phone: 970-663-7780
  • Fax: 970-663-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1011100555
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3071
License Number StateCO

VIII. Authorized Official

Name: WHITNEY BENECK
Title or Position: SECRETARY
Credential: PT
Phone: 970-663-7780