Provider Demographics
NPI:1124383930
Name:JOINT EFFORT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:JOINT EFFORT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-583-7183
Mailing Address - Street 1:2989 BROADMOOR VALLEY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4403
Mailing Address - Country:US
Mailing Address - Phone:719-527-9331
Mailing Address - Fax:
Practice Address - Street 1:2989 BROADMOOR VALLEY RD STE D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4403
Practice Address - Country:US
Practice Address - Phone:719-527-9331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-08
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9310261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9310Medicaid
TN=========XMedicaid