Healthcare Provider Details

I. General information

NPI: 1548218241
Provider Name (Legal Business Name): ALTITUDE PHYSICAL THERAPY & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7833 W 38TH AVE
WHEAT RIDGE CO
80033-6109
US

IV. Provider business mailing address

PO BOX 21150
BOULDER CO
80308-4150
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-6534
  • Fax: 303-425-0427
Mailing address:
  • Phone: 303-546-9158
  • Fax: 303-546-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SANDRA CRANNY
Title or Position: VICE-PRESIDENT
Credential: P.T.
Phone: 303-425-6534