Provider Demographics
NPI:1215027628
Name:PROFESSIONAL THERAPY SERVICES INC
Entity Type:Organization
Organization Name:PROFESSIONAL THERAPY SERVICES INC
Other - Org Name:PROFESSIONAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAIZE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA OTR/L
Authorized Official - Phone:970-596-2007
Mailing Address - Street 1:1543 OGDEN RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5683
Mailing Address - Country:US
Mailing Address - Phone:970-252-0888
Mailing Address - Fax:970-252-9226
Practice Address - Street 1:1543 OGDEN RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5683
Practice Address - Country:US
Practice Address - Phone:970-252-0888
Practice Address - Fax:970-252-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80576OtherSLOANS LAKE
CO49103822Medicaid
CO66332OtherBLUE CROSS BLUE SHIELD
CO66332OtherBLUE CROSS BLUE SHIELD
CO80576OtherSLOANS LAKE
CO66332OtherBLUE CROSS BLUE SHIELD