Provider Demographics
NPI:1235729567
Name:ALTITUDE PHYSICAL THERAPY & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:ALTITUDE PHYSICAL THERAPY & SPORTS MEDICINE LLC
Other - Org Name:ALTITUDE PHYSICAL THERAPY - LONGMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CRANNY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-444-0378
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:275 S MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6461
Practice Address - Country:US
Practice Address - Phone:303-776-3800
Practice Address - Fax:303-776-3806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTITUDE PHYSICAL THERAPY & SPORTS MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy