Provider Demographics
NPI:1407976558
Name:MOUNTAINTOP PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MOUNTAINTOP PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:970-577-8200
Mailing Address - Street 1:1632 BIG THOMPSON AVE # A
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-8938
Mailing Address - Country:US
Mailing Address - Phone:970-577-8200
Mailing Address - Fax:970-577-8204
Practice Address - Street 1:1632 BIG THOMPSON AVE # A
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-8938
Practice Address - Country:US
Practice Address - Phone:970-577-8200
Practice Address - Fax:970-577-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7376261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5338090001Medicare NSC