Provider Demographics
NPI:1497784102
Name:HIGH PLAINS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:HIGH PLAINS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENECK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-663-7780
Mailing Address - Street 1:3880 GRANT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8433
Mailing Address - Country:US
Mailing Address - Phone:970-663-7780
Mailing Address - Fax:970-663-7781
Practice Address - Street 1:3880 GRANT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8433
Practice Address - Country:US
Practice Address - Phone:970-663-7780
Practice Address - Fax:970-663-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3071225100000X
CO1011100555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09873546Medicaid
COC501588Medicare ID - Type Unspecified