Provider Demographics
NPI:1093877565
Name:PERFORMAX FRONT RANGE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PERFORMAX FRONT RANGE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSPEH
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIXEIRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:303-932-2500
Mailing Address - Street 1:5920 S ESTES ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-8618
Mailing Address - Country:US
Mailing Address - Phone:303-932-2500
Mailing Address - Fax:303-932-2600
Practice Address - Street 1:7600 E EASTMAN AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4376
Practice Address - Country:US
Practice Address - Phone:720-747-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC542318Medicare PIN