Healthcare Provider Details

I. General information

NPI: 1952528200
Provider Name (Legal Business Name): ALL STAR PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 HARLAN ST UNIT 225
WESTMINSTER CO
80031-2926
US

IV. Provider business mailing address

359 JACKSON ST
LAFAYETTE CO
80026-9202
US

V. Phone/Fax

Practice location:
  • Phone: 303-420-1998
  • Fax: 303-420-1650
Mailing address:
  • Phone: 303-420-1998
  • Fax: 303-420-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7748
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number7748
License Number StateCO

VIII. Authorized Official

Name: MR. DAVID A. VISLOSKY
Title or Position: PRESIDENT/PHYSICAL THERAPIST
Credential: PHYSICAL THERAPIST
Phone: 303-420-1998