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General NPI Number Information
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NPI Number | 1376162883
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Entity Type | Organization
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Legal Business Name | VAIL PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 1295 WESTHAVEN DR
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City | VAIL
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State | CO
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Zip | 81657-4395
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Country | US
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Telephone | 970-476-7510
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Fax | 970-476-7511
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Provider Business Mailing Address
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Address Line | 570 HOMESTEAD DR APT 38
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City | EDWARDS
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State | CO
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Zip | 81632-8162
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MARTIN
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Credential |
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Telephone | 612-799-9192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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