=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649229089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL THERAPY & INDUSTRIAL SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 08/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3601 S PEARL ST SUITE 200
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80113-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-757-1554
-----------------------------------------------------
Fax | 303-757-3104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3601 S PEARL ST SUITE 200
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80113-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-757-1554
-----------------------------------------------------
Fax | 303-757-3104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE DIRECTOR
-----------------------------------------------------
Name | RENEE J GONZALEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-757-1554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 2357
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------