Provider Demographics
NPI:1154662591
Name:TAKE CHARGE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:TAKE CHARGE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LOVATO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:719-651-2447
Mailing Address - Street 1:17110 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8156
Mailing Address - Country:US
Mailing Address - Phone:719-651-2447
Mailing Address - Fax:719-488-6547
Practice Address - Street 1:325 SECOND ST STE O
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7935
Practice Address - Country:US
Practice Address - Phone:719-481-3747
Practice Address - Fax:719-488-6547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2201261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy