Provider Demographics
NPI:1326791294
Name:COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL LLC
Entity Type:Organization
Organization Name:COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDFERN CATALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-567-2400
Mailing Address - Street 1:PO BOX 392977
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-5238
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4060
Practice Address - Street 1:10439 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-8929
Practice Address - Country:US
Practice Address - Phone:720-625-8198
Practice Address - Fax:720-792-4514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-01
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty