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General NPI Number Information
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NPI Number | 1225498009
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Entity Type | Organization
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Legal Business Name | JUMP START PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 555 E 10TH AVE #502
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City | DENVER
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State | CO
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Zip | 80203-3255
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Country | US
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Telephone | 303-909-5743
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Fax |
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Provider Business Mailing Address
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Address Line | 555 E 10TH AVE #502
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City | DENVER
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State | CO
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Zip | 80203-3255
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Country | US
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Telephone | 303-909-5743
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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 | KELLY N THORNTON
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Credential | DPT
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Telephone | 303-909-5743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 11022
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License Number State | CO
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