MEDICARE: COAL CREEK 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	261QP2000X	Physical Therapy Clinic/Center
2	225100000X	Physical Therapist		CO

General Provider Information

NPI Number	:	1740238120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAL CREEK PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	315 W SOUTH BOULDER RD
Second Line	:	STE. # 100
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1156
Country	:	US
Telephone Number	:	303-666-4151
Fax Number	:	303-666-4166

Provider Business Practice Location Address
First Line	:	315 W SOUTH BOULDER RD
Second Line	:	STE. # 100
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1156
Country	:	US
Telephone Number	:	303-666-4151
Fax Number	:	303-666-4166

Authorized Official
Title or Position	:	CLINIC OWNER
Name	:	MS. JULIE A BYRT
Credential	:	MSPT
Telephone Number	:	720-891-0532

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	05/20/2013

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