Provider Demographics
NPI:1023198330
Name:PHYSICAL THERAPY OF LAKEWOOD LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF LAKEWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:O
Authorized Official - Last Name:WORSWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-239-8900
Mailing Address - Street 1:480 S ALLISON PKWY
Mailing Address - Street 2:CIVIC CENTER S, 2ND FLOOR
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3123
Mailing Address - Country:US
Mailing Address - Phone:303-239-8900
Mailing Address - Fax:303-239-0354
Practice Address - Street 1:480 S ALLISON PKWY
Practice Address - Street 2:CIVIC CENTER S, 2ND FLOOR
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3123
Practice Address - Country:US
Practice Address - Phone:303-239-8900
Practice Address - Fax:303-239-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803787Medicare PIN