Provider Demographics
NPI:1093456808
Name:ADVANCED INJURY TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED INJURY TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HASSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-929-9193
Mailing Address - Street 1:12071 TEJON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2320
Mailing Address - Country:US
Mailing Address - Phone:720-702-0600
Mailing Address - Fax:303-648-5877
Practice Address - Street 1:12071 TEJON ST STE 300
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2320
Practice Address - Country:US
Practice Address - Phone:720-702-0600
Practice Address - Fax:303-648-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty