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General NPI Number Information
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NPI Number | 1306924659
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR PHYSICAL WELLNESS, INC.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1776 S JACKSON ST SUITE 820
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City | DENVER
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State | CO
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Zip | 80210-3801
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Country | US
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Telephone | 303-300-6842
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Fax | 303-758-1260
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Provider Business Mailing Address
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Address Line | 1776 S JACKSON ST STE 820
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City | DENVER
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State | CO
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Zip | 80210-3807
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Country | US
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Telephone | 303-300-6842
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Fax | 303-758-1260
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STACY ANN TUCKWELL
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Credential | MPT
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Telephone | 303-300-6842
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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 | 4164
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License Number State | CO
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