Provider Demographics
NPI:1437395019
Name:COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL LLC
Entity Type:Organization
Organization Name:COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL LLC
Other - Org Name:COLORADO ATHLETIC CONDITIONING CLINIC LINCOLN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDFERN CATALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-567-2400
Mailing Address - Street 1:PO BOX 392977
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-5528
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4068
Practice Address - Street 1:10450 PARK MEADOWS DR STE 103
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-790-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804320Medicare PIN