MEDICARE: SAGE PHYSICAL 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1588352595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	1279 S SHERMAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-1512
Country	:	US
Telephone Number	:	440-823-9383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1872 SOUTH PEARL STREET
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-1512
Country	:	US
Telephone Number	:	303-335-9661
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERINE ELIZABETH KOCH
Credential	:	DPT
Telephone Number	:	440-823-9383

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	06/26/2023

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