Provider Demographics
NPI:1265642243
Name:HEALTHTECH THERAPY & SPORTS PERFORMANCE INC.
Entity Type:Organization
Organization Name:HEALTHTECH THERAPY & SPORTS PERFORMANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-977-9393
Mailing Address - Street 1:405 W 115TH AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3097
Mailing Address - Country:US
Mailing Address - Phone:720-977-9393
Mailing Address - Fax:720-977-9363
Practice Address - Street 1:405 W 115TH AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3097
Practice Address - Country:US
Practice Address - Phone:720-977-9393
Practice Address - Fax:720-977-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO54902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty