Healthcare Provider Details

I. General information

NPI: 1427607340
Provider Name (Legal Business Name): MOUNTAIN STATES HAND AND PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 WADSWORTH BLVD STE 210
WHEAT RIDGE CO
80033-4624
US

IV. Provider business mailing address

4045 WADSWORTH BLVD STE 210
WHEAT RIDGE CO
80033-4624
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-3163
  • Fax: 303-245-0726
Mailing address:
  • Phone: 303-953-3163
  • Fax: 303-245-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHEILA JANAE MORTON
Title or Position: OWNER/PARTNER
Credential:
Phone: 303-953-3163