MEDICARE: PHYSICOR REHABILITATION 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	7314	CO

General Provider Information

NPI Number	:	1912943564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICOR REHABILITATION LLC

Provider Business Mailing Address
First Line	:	PO BOX 40189
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-0189
Country	:	US
Telephone Number	:	303-884-3118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 S ALBION ST
Second Line	:	SUITE 1001
City	:	DENVER
State	:	CO
Zip	:	80222-4046
Country	:	US
Telephone Number	:	303-884-3118
Fax Number	:	303-862-8221

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	MR. OSVALDO BALDESSARI
Credential	:	P.T.
Telephone Number	:	303-884-3118

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	02/27/2014

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