Provider Demographics
NPI:1235598350
Name:VILLAGE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:VILLAGE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:719-577-4104
Mailing Address - Street 1:545 E PIKES PEAK AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3637
Mailing Address - Country:US
Mailing Address - Phone:719-577-4104
Mailing Address - Fax:719-575-0872
Practice Address - Street 1:1184 SOUTH PERRY STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104
Practice Address - Country:US
Practice Address - Phone:719-577-4104
Practice Address - Fax:719-575-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty