Provider Demographics
NPI:1114998788
Name:COLORADO PHYSICAL THERAPY INSTITUTE, P.C.
Entity Type:Organization
Organization Name:COLORADO PHYSICAL THERAPY INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:RETTIG
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-460-9129
Mailing Address - Street 1:300 NICKEL ST
Mailing Address - Street 2:STE 6
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2097
Mailing Address - Country:US
Mailing Address - Phone:303-460-9129
Mailing Address - Fax:303-469-2324
Practice Address - Street 1:300 NICKEL ST
Practice Address - Street 2:STE 6
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2097
Practice Address - Country:US
Practice Address - Phone:303-460-9129
Practice Address - Fax:303-469-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2539174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24950769Medicaid
CO066570Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER