Provider Demographics
NPI:1225296809
Name:PRESTIGE HEALTHCARE ASSOCIATES, LPA
Entity Type:Organization
Organization Name:PRESTIGE HEALTHCARE ASSOCIATES, LPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MERICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOJUT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-232-7800
Mailing Address - Street 1:1805 KIPLING ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-2873
Mailing Address - Country:US
Mailing Address - Phone:303-232-7800
Mailing Address - Fax:303-232-7802
Practice Address - Street 1:1805 KIPLING ST
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-2873
Practice Address - Country:US
Practice Address - Phone:303-232-7800
Practice Address - Fax:303-232-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6107261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy