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General NPI Number Information
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NPI Number | 1972545630
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8200 E BELLEVIEW AVE SUITE 426C
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2803
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Country | US
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Telephone | 303-221-5757
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Fax | 303-221-5759
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Provider Business Mailing Address
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Address Line | 8200 E BELLEVIEW AVE SUITE 426C
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2803
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Country | US
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Telephone | 303-221-5757
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Fax | 303-221-5759
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Authorized Official
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Title or Position | PRESIDENT PHYSICAL THERAPIST
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Name | MR. MICHAEL SHANE BRYANT
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Credential | M.S.P.T.
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Telephone | 303-221-5757
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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 | 6661
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License Number State | CO
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