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General NPI Number Information
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NPI Number | 1528534740
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Entity Type | Organization
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Legal Business Name | 11-11 PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 6851 S HOLLY CIR STE 100
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City | CENTENNIAL
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State | CO
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Zip | 80112-1040
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Country | US
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Telephone | 303-771-3745
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Fax | 303-771-3728
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Provider Business Mailing Address
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Address Line | 6851 S HOLLY CIR STE 100
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City | CENTENNIAL
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State | CO
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Zip | 80112-1040
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Country | US
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Telephone | 303-771-3745
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Fax | 303-771-3728
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE ANNE COOPER
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Credential | PT
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Telephone | 303-471-6212
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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 |
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License Number State |
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