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General NPI Number Information
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NPI Number | 1184878308
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL PHYSICAL THERAPY, LLC, A COLORADO PROFESSIONAL COMPANY
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 1412 W 38TH AVE
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City | DENVER
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State | CO
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Zip | 80211-2617
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Country | US
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Telephone | 970-846-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 KALMIA AVE APT C318
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City | BOULDER
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State | CO
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Zip | 80301-1590
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Country | US
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Telephone | 970-846-3300
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. NANCY GALE HACKETT HARRISON
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Credential | MSPT, CFMT, FMTF
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Telephone | 970-846-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 6843
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License Number State | CO
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