Provider Demographics
NPI:1467531707
Name:BROOKSIDE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BROOKSIDE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:303-428-4646
Mailing Address - Street 1:8859 FOX DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260
Mailing Address - Country:US
Mailing Address - Phone:303-428-4646
Mailing Address - Fax:303-429-6255
Practice Address - Street 1:8859 FOX DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260
Practice Address - Country:US
Practice Address - Phone:303-428-4646
Practice Address - Fax:303-429-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066587Medicare Oscar/Certification