MEDICARE: RELIEVA PT, 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	2335	CO

General Provider Information

NPI Number	:	1871563312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIEVA PT, LLC

Provider Business Mailing Address
First Line	:	4025 AUTOMATION WAY
Second Line	:	SUITE B1
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3446
Country	:	US
Telephone Number	:	970-472-1072
Fax Number	:	970-472-1071

Provider Business Practice Location Address
First Line	:	4025 AUTOMATION WAY
Second Line	:	SUITE B1
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3446
Country	:	US
Telephone Number	:	970-472-1072
Fax Number	:	970-472-1071

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DENNIS HAZLETT
Credential	:
Telephone Number	:	970-472-1072

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/22/2020

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