Provider Demographics
NPI:1083732689
Name:COLORADO CTR FOR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COLORADO CTR FOR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-797-0988
Mailing Address - Street 1:2329 W MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8200
Mailing Address - Country:US
Mailing Address - Phone:303-797-0988
Mailing Address - Fax:303-797-8011
Practice Address - Street 1:2329 W MAIN ST
Practice Address - Street 2:STE 211
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8210
Practice Address - Country:US
Practice Address - Phone:303-797-0988
Practice Address - Fax:303-797-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800344Medicare PIN