Provider Demographics
NPI:1366442758
Name:FIT PHYSICAL THERAPY PROF LLC
Entity Type:Organization
Organization Name:FIT PHYSICAL THERAPY PROF LLC
Other - Org Name:FYZICAL THERAPY & BALANCE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-409-2133
Mailing Address - Street 1:6612 S WARD ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4855
Mailing Address - Country:US
Mailing Address - Phone:303-409-2133
Mailing Address - Fax:303-409-2233
Practice Address - Street 1:6612 S WARD ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4855
Practice Address - Country:US
Practice Address - Phone:303-409-2133
Practice Address - Fax:303-409-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO660925OtherBCBS PROVIDER #
CO660925OtherBCBS PROVIDER #