Provider Demographics
NPI:1053077040
Name:MYOTHERAPY PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:MYOTHERAPY PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-392-9781
Mailing Address - Street 1:710 S DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-3525
Mailing Address - Country:US
Mailing Address - Phone:832-392-9781
Mailing Address - Fax:
Practice Address - Street 1:8821 E HAMPDEN AVE STE 113
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4951
Practice Address - Country:US
Practice Address - Phone:720-432-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty