Healthcare Provider Details

I. General information

NPI: 1376162883
Provider Name (Legal Business Name): VAIL PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 WESTHAVEN DR
VAIL CO
81657-4395
US

IV. Provider business mailing address

570 HOMESTEAD DR APT 38
EDWARDS CO
81632-8162
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-7510
  • Fax: 970-476-7511
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MARTIN
Title or Position: OWNER
Credential:
Phone: 612-799-9192