Provider Demographics
NPI:1164510038
Name:PURPOSE MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PURPOSE MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:BODY IN BALANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, CPT
Authorized Official - Phone:303-477-5303
Mailing Address - Street 1:2828 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1429
Mailing Address - Country:US
Mailing Address - Phone:303-477-5303
Mailing Address - Fax:303-477-5302
Practice Address - Street 1:2828 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1429
Practice Address - Country:US
Practice Address - Phone:303-477-5303
Practice Address - Fax:303-477-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO58522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72435313Medicaid
CO801966Medicare ID - Type UnspecifiedGROUP