Provider Demographics
NPI:1497334791
Name:THE NOURISHED PT, LLC
Entity Type:Organization
Organization Name:THE NOURISHED PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-446-5600
Mailing Address - Street 1:7711 TELLER ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2226
Mailing Address - Country:US
Mailing Address - Phone:720-466-5600
Mailing Address - Fax:720-696-9987
Practice Address - Street 1:6452 FIG ST UNIT C
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-1060
Practice Address - Country:US
Practice Address - Phone:720-466-5600
Practice Address - Fax:720-696-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty