Provider Demographics
NPI:1033315809
Name:BERTHOUD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BERTHOUD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURTAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-532-7500
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-1848
Mailing Address - Country:US
Mailing Address - Phone:970-532-7500
Mailing Address - Fax:970-532-7510
Practice Address - Street 1:516 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513
Practice Address - Country:US
Practice Address - Phone:970-532-7500
Practice Address - Fax:970-532-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6456261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO488358Medicare ID - Type Unspecified