Provider Demographics
NPI:1154064236
Name:ROOTS PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:ROOTS PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:ROOTS PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FINCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:720-704-7401
Mailing Address - Street 1:2297 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7988
Mailing Address - Country:US
Mailing Address - Phone:720-704-7401
Mailing Address - Fax:
Practice Address - Street 1:168 CTC BLVD UNIT D
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-3093
Practice Address - Country:US
Practice Address - Phone:720-704-7401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1659783850OtherNOT TAKING MEDICAID OR COMMERCIAL INSURANCE