Provider Demographics
NPI:1326339722
Name:AGILITY PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:AGILITY PHYSICAL THERAPY AND SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CATALLO-MADRUGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CFDN
Authorized Official - Phone:303-641-0887
Mailing Address - Street 1:9034 E EASTER PL STE 207
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2104
Mailing Address - Country:US
Mailing Address - Phone:303-773-0771
Mailing Address - Fax:303-773-0773
Practice Address - Street 1:7375 E ORCHARD RD STE 200
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2510
Practice Address - Country:US
Practice Address - Phone:303-773-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8977261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAAA1608Medicare PIN
COC477678Medicare PIN