Provider Demographics
NPI:1467109629
Name:DA VINCI PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:DA VINCI PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALEB
Authorized Official - Suffix:
Authorized Official - Credentials:MPY
Authorized Official - Phone:719-940-1220
Mailing Address - Street 1:201 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2771
Mailing Address - Country:US
Mailing Address - Phone:719-940-1220
Mailing Address - Fax:
Practice Address - Street 1:201 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2771
Practice Address - Country:US
Practice Address - Phone:719-940-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty