MEDICARE: PARK MEADOWS PHYSICAL THERAPY

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	174400000X	Specialist

General Provider Information

NPI Number	:	1730276171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK MEADOWS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 21150
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80308-4150
Country	:	US
Telephone Number	:	720-344-7034
Fax Number	:	720-344-7032

Provider Business Practice Location Address
First Line	:	8671 S QUEBEC ST STE 130
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80130-5860
Country	:	US
Telephone Number	:	720-344-7034
Fax Number	:	720-344-7032

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	ANGIE STAACK
Credential	:
Telephone Number	:	303-680-6121

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	06/15/2010

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Directions to “PARK MEADOWS PHYSICAL THERAPY ” Practice Location

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