Provider Demographics
NPI:1295359776
Name:CARBON CREEK PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CARBON CREEK PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-327-8872
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-0335
Mailing Address - Country:US
Mailing Address - Phone:209-327-8872
Mailing Address - Fax:
Practice Address - Street 1:405 W TOMICHI AVE
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2713
Practice Address - Country:US
Practice Address - Phone:970-901-7684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy