Provider Demographics
NPI:1235872912
Name:ROOTS PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:ROOTS PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FINCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:720-704-7401
Mailing Address - Street 1:2297 DOGWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516
Mailing Address - Country:US
Mailing Address - Phone:505-400-3234
Mailing Address - Fax:
Practice Address - Street 1:168 CTC BLVD UNIT D
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:720-704-7401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy