Provider Demographics
NPI:1083905624
Name:FINISHLINE PHYSICAL THERAPY & SPORTS REHAB, LLC
Entity Type:Organization
Organization Name:FINISHLINE PHYSICAL THERAPY & SPORTS REHAB, LLC
Other - Org Name:FINISHLINE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-997-7743
Mailing Address - Street 1:2030 E COUNTY LINE RD UNIT M
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-2439
Mailing Address - Country:US
Mailing Address - Phone:303-997-7743
Mailing Address - Fax:303-997-7885
Practice Address - Street 1:2030 E COUNTY LINE RD UNIT M
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-2439
Practice Address - Country:US
Practice Address - Phone:303-997-7743
Practice Address - Fax:303-997-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-01
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09434356Medicaid