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General NPI Number Information
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NPI Number | 1811886732
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Entity Type | Organization
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Legal Business Name | PHOENIX PT AND SPORTS REHABILITATION LLC
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 2452 SILVERTON ST
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City | LOVELAND
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State | CO
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Zip | 80538-6209
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Country | US
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Telephone | 770-377-4380
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Fax |
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Provider Business Mailing Address
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Address Line | 2452 SILVERTON ST
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City | LOVELAND
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State | CO
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Zip | 80538-6209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | TYLER SHANDRA
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Credential | DPT
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Telephone | 714-743-7311
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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 |
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License Number State |
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