Provider Demographics
NPI:1447762745
Name:PRIMEAU PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PRIMEAU PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PRIMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-901-9725
Mailing Address - Street 1:2943 W RIVERWALK CIR UNIT O
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-7114
Mailing Address - Country:US
Mailing Address - Phone:303-901-9725
Mailing Address - Fax:
Practice Address - Street 1:2943 W RIVERWALK CIR UNIT O
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7114
Practice Address - Country:US
Practice Address - Phone:303-901-9725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL11361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty