Provider Demographics
NPI:1356510721
Name:ELWOOD PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ELWOOD PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ELWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:720-244-1690
Mailing Address - Street 1:4950 S YOSEMITE ST
Mailing Address - Street 2:F2 #213
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1349
Mailing Address - Country:US
Mailing Address - Phone:720-244-1690
Mailing Address - Fax:720-570-7996
Practice Address - Street 1:38 E 5TH AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3436
Practice Address - Country:US
Practice Address - Phone:303-893-0047
Practice Address - Fax:720-570-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8402174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800067Medicare PIN