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General NPI Number Information
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NPI Number | 1992876148
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY CENTER, INC.
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 1330 SUNSET ST
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City | LONGMONT
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State | CO
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Zip | 80501-3218
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Country | US
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Telephone | 303-776-0333
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Fax | 303-776-0107
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Provider Business Mailing Address
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Address Line | 1330 SUNSET ST
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City | LONGMONT
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State | CO
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Zip | 80501-3218
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Country | US
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Telephone | 303-776-0333
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Fax | 303-776-0107
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KIM RIVERA
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Credential |
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Telephone | 303-776-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2550
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License Number State | CO
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