Provider Demographics
NPI:1417979857
Name:INDEPENDENT PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:INDEPENDENT PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:BOOKOUT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-410-8178
Mailing Address - Street 1:10359 NORTH FEDERAL BLVD.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80260
Mailing Address - Country:US
Mailing Address - Phone:303-410-8178
Mailing Address - Fax:303-410-2573
Practice Address - Street 1:10359 NORTH FEDERAL BLVD.
Practice Address - Street 2:SUITE 205
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80260
Practice Address - Country:US
Practice Address - Phone:303-410-8178
Practice Address - Fax:303-410-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CON5303Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER