=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972915288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPYDIA COLORADO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2014
-----------------------------------------------------
Last Update Date | 03/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1650 N GRANT ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-2710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-482-1540
-----------------------------------------------------
Fax | 303-482-1545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 N GRANT ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-482-1540
-----------------------------------------------------
Fax | 303-482-1545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARCO MEYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-328-3332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------