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General NPI Number Information
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NPI Number | 1609255983
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL SPORTS HEALTH LLC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 6030 GREENWOOD PLAZA BLVD STE 110
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-4825
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Country | US
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Telephone | 303-720-0603
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Fax | 303-770-4184
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Provider Business Mailing Address
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Address Line | 6030 GREENWOOD PLAZA BLVD STE 110
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-4825
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Country | US
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Telephone |
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Fax | 303-770-4184
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Authorized Official
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Title or Position | CEO
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Name | MR. HYO KIM
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Credential |
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Telephone | 303-720-0603
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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 | 7946
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License Number State | CO
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