Healthcare Provider Details

I. General information

NPI: 1003742883
Provider Name (Legal Business Name): FLORES MOBILE PT PROFESSIONAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 STARLITE DR
PUEBLO CO
81005-2691
US

IV. Provider business mailing address

544 STARLITE DR
PUEBLO CO
81005-2691
US

V. Phone/Fax

Practice location:
  • Phone: 719-214-0723
  • Fax:
Mailing address:
  • Phone: 719-214-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL FLORES
Title or Position: OWNER
Credential: DPT
Phone: 719-214-0723