MEDICARE: DORSA 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	261QP2000X	Physical Therapy Clinic/Center	4743	CO

General Provider Information

NPI Number	:	1952414237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORSA PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	214 8TH STREET
Second Line	:	SUITE 306
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3326
Country	:	US
Telephone Number	:	970-945-1467
Fax Number	:	970-945-1392

Provider Business Practice Location Address
First Line	:	214 8TH STREET
Second Line	:	SUITE 306
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3326
Country	:	US
Telephone Number	:	970-945-1467
Fax Number	:	970-945-1392

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PETER G DORSA
Credential	:	MSPT
Telephone Number	:	970-945-1467

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	12/27/2007

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Directions to “DORSA PHYSICAL THERAPY ” Practice Location

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