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General NPI Number Information
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NPI Number | 1437633658
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Entity Type | Individual
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Provider Name | THOMAS KENNETH BACKE PT, DPT, CLT
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Gender | Male
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 16420 W US HIGHWAY 24
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City | WOODLAND PARK
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State | CO
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Zip | 80863-8760
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Country | US
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Telephone | 719-374-6172
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Fax | 719-374-6118
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Provider Business Mailing Address
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Address Line | 16420 W US HIGHWAY 24
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City | WOODLAND PARK
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State | CO
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Zip | 80863-8760
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Country | US
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Telephone | 719-374-6172
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Fax | 719-374-6118
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PTL.0015815
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305212280
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4430
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License Number State | NH
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