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General NPI Number Information
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NPI Number | 1700307618
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Entity Type | Organization
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Legal Business Name | ALTIUS REHABILITATION AND WELLNESS, PLLC
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 850 CHAMBERS AVE
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City | EAGLE
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State | CO
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Zip | 81631-0101
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Country | US
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Telephone | 970-343-4641
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 101
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City | EAGLE
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State | CO
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Zip | 81631-0101
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Country | US
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Telephone | 970-343-4641
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Fax |
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Authorized Official
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Title or Position | OWNER-PARTNER/PHYSICAL THERAPIST
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Name | MR. THEODORE MICHAEL WEBER
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Credential | PT, OPT, OCS
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Telephone | 970-343-4641
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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 | 9679
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License Number State | CO
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