Provider Demographics
NPI:1467738583
Name:TABLE MOUNTAIN ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:TABLE MOUNTAIN ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, PLLC
Other - Org Name:SIRONA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-279-9728
Mailing Address - Street 1:1216 ARAPAHOE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1124
Mailing Address - Country:US
Mailing Address - Phone:303-279-9728
Mailing Address - Fax:303-278-0180
Practice Address - Street 1:1216 ARAPAHOE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1124
Practice Address - Country:US
Practice Address - Phone:303-279-9728
Practice Address - Fax:303-278-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty