MEDICARE: DENVER PEDIATRIC THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1124602727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	4334 NW EXPRESSWAY STE 187
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	393 S HARLAN ST STE 110
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-3569
Country	:	US
Telephone Number	:	405-247-0285
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	KATIE ECKART
Credential	:
Telephone Number	:	405-247-0285

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	01/05/2022

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