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NPI Code Detail

MEDICARE: FUNCTIONAL PERFORMANCE PHYSICAL THERAPY CENTER

MEDICARE: FUNCTIONAL PERFORMANCE PHYSICAL THERAPY CENTER
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
1261QP2000XPhysical Therapy Clinic/Center9903CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11518193895OTHERCONPI- ORGANIZATION

General Provider Information

NPI Number : 1679703888
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUNCTIONAL PERFORMANCE PHYSICAL THERAPY CENTER
Provider Business Mailing Address
First Line : 6169 S BALSAM WAY
Second Line : STE 110
City : LITTLETON
State : CO
Zip : 80123-3062
Country : US
Telephone Number : 303-948-1868
Fax Number : 303-948-1741
Provider Business Practice Location Address
First Line : 12257 S WADSWORTH BLVD
Second Line :
City : LITTLETON
State : CO
Zip : 80125-8504
Country : US
Telephone Number : 303-981-9870
Fax Number : 303-416-4271
Authorized Official
Title or Position : DIRECTOR
Name : JUSTIN CLIFFORD
Credential : PT, DPT
Telephone Number : 303-981-9870
Provider Enumeration Date : 07/22/2009
Last Update Date : 12/02/2009

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Directions to “FUNCTIONAL PERFORMANCE PHYSICAL THERAPY CENTER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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