Provider Demographics
NPI:1225715345
Name:TRANSFORMATIVE PAIN CARE AND PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:TRANSFORMATIVE PAIN CARE AND PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-208-4890
Mailing Address - Street 1:546 APRICOT LN
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-3067
Mailing Address - Country:US
Mailing Address - Phone:970-639-1948
Mailing Address - Fax:970-808-2006
Practice Address - Street 1:546 APRICOT LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3067
Practice Address - Country:US
Practice Address - Phone:970-639-1948
Practice Address - Fax:970-808-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty