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General NPI Number Information
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NPI Number | 1457624439
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Entity Type | Organization
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Legal Business Name | ENDURANCE SPORTS PERFORMANCE AND REHABILITATION, INC
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 600 S AIRPORT RD BLDG B, SUITE C
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City | LONGMONT
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State | CO
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Zip | 80503-6424
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Country | US
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Telephone | 720-491-3402
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Fax |
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Provider Business Mailing Address
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Address Line | 600 S AIRPORT RD BLDG B, SUITE C
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City | LONGMONT
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State | CO
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Zip | 80503-6424
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Country | US
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Telephone | 720-491-3402
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM BRIAN GRIFFIN
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Credential | MSPT, ATC, USAT1
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Telephone | 720-491-3402
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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 | PT22897
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License Number State | FL
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