Provider Demographics
NPI:1477155737
Name:PHYSIO PRO, INC.
Entity Type:Organization
Organization Name:PHYSIO PRO, INC.
Other - Org Name:EVOLUTION PHYSIO PRO
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:303-370-2670
Mailing Address - Street 1:3801 E FLORIDA AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210
Mailing Address - Country:US
Mailing Address - Phone:303-370-2670
Mailing Address - Fax:303-370-2696
Practice Address - Street 1:10315 S PROGRESS WAY UNIT 8
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4000
Practice Address - Country:US
Practice Address - Phone:720-773-8082
Practice Address - Fax:720-776-3411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSIO PRO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-12
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty