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General NPI Number Information
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NPI Number | 1528829975
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Entity Type | Organization
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Legal Business Name | PRO ATHLETE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 17800 W COLFAX AVE
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City | GOLDEN
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State | CO
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Zip | 80401-5605
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Country | US
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Telephone | 916-860-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 S ABILENE ST # 440751
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City | AURORA
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State | CO
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Zip | 80014-2322
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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/PHYSICAL THERAPIST
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Name | EDWIN PORRAS
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Credential | DPT
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Telephone | 916-860-2540
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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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