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General NPI Number Information
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NPI Number | 1548289838
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Entity Type | Organization
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Legal Business Name | ONE80 PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 1694 TOPAZ DRIVE
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City | LOVELAND
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State | CO
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Zip | 80537-3210
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Country | US
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Telephone | 970-593-9300
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Fax | 970-593-9318
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Provider Business Mailing Address
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Address Line | 1694 TOPAZ DRIVE
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City | LOVELAND
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State | CO
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Zip | 80537-3210
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Country | US
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Telephone | 970-593-9300
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Fax | 970-593-9318
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RHETT E POLKA
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Credential | DPT
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Telephone | 970-593-9300
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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 | 7307
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License Number State | CO
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