Healthcare Provider Details

I. General information

NPI: 1790661577
Provider Name (Legal Business Name): THE SPACE PT LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7872 TOMPKINS RD
PEYTON CO
80831-6135
US

IV. Provider business mailing address

7872 TOMPKINS RD
PEYTON CO
80831-6135
US

V. Phone/Fax

Practice location:
  • Phone: 719-200-5233
  • Fax: 719-960-3008
Mailing address:
  • Phone: 719-200-5233
  • Fax: 719-960-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON RAZAK
Title or Position: OWNER
Credential: DPT
Phone: 785-764-6670