Provider Demographics
NPI:1023222312
Name:MOUNTAIN STATES HAND AND PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MOUNTAIN STATES HAND AND PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:JANAE
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
Authorized Official - Phone:303-953-3163
Mailing Address - Street 1:4045 WADSWORTH BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4624
Mailing Address - Country:US
Mailing Address - Phone:303-953-3163
Mailing Address - Fax:303-245-0726
Practice Address - Street 1:4045 WADSWORTH BLVD STE 210
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4624
Practice Address - Country:US
Practice Address - Phone:303-953-3163
Practice Address - Fax:303-245-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000110247Medicaid
CO9000166732Medicaid
CO03800067Medicaid