Provider Demographics
NPI:1225392871
Name:HEIGHTS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:HEIGHTS PHYSICAL THERAPY LLC
Other - Org Name:HEIGHTS PERFORMANCE AND REHABILITATION SPECIALISTS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:EZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-901-9315
Mailing Address - Street 1:700 N MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2423
Mailing Address - Country:US
Mailing Address - Phone:970-641-3298
Mailing Address - Fax:970-641-7369
Practice Address - Street 1:700 N MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2423
Practice Address - Country:US
Practice Address - Phone:970-641-3298
Practice Address - Fax:970-641-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9752261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01125044Medicaid