Provider Demographics
NPI:1417643537
Name:MICHAEL STIWICH PT LLC
Entity Type:Organization
Organization Name:MICHAEL STIWICH PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:STIWICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-262-0264
Mailing Address - Street 1:19195 E STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2861
Mailing Address - Country:US
Mailing Address - Phone:352-262-0264
Mailing Address - Fax:
Practice Address - Street 1:2305 E ARAPAHOE RD STE 218
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1538
Practice Address - Country:US
Practice Address - Phone:720-422-1446
Practice Address - Fax:303-955-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty