Provider Demographics
NPI:1225498009
Name:JUMP START PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JUMP START PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-909-5743
Mailing Address - Street 1:555 E 10TH AVE
Mailing Address - Street 2:#502
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3255
Mailing Address - Country:US
Mailing Address - Phone:303-909-5743
Mailing Address - Fax:
Practice Address - Street 1:555 E 10TH AVE
Practice Address - Street 2:#502
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3255
Practice Address - Country:US
Practice Address - Phone:303-909-5743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO110222251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37979264Medicaid