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General NPI Number Information
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NPI Number | 1699924506
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Entity Type | Organization
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Legal Business Name | BLUE SKY PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 155 S MADISON ST SUITE 303
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City | DENVER
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State | CO
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Zip | 80209-3011
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Country | US
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Telephone | 303-917-8952
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Fax |
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Provider Business Mailing Address
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Address Line | 155 S MADISON ST SUITE 303
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City | DENVER
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State | CO
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Zip | 80209-3011
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Country | US
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Telephone | 303-917-8952
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Fax |
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Authorized Official
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Title or Position | OWNER/OFFICER/PHYSICAL THERAPIST
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Name | JENNIFER ELISE LANE
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Credential | MPT
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Telephone | 303-917-8952
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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 | 8000
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License Number State | CO
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