Provider Demographics
NPI:1518193895
Name:FUNCTIONAL PERFORMANCE PHYSICAL THERAPY CENTER, PLLC
Entity Type:Organization
Organization Name:FUNCTIONAL PERFORMANCE PHYSICAL THERAPY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-948-1868
Mailing Address - Street 1:6169 S BALSAM WAY
Mailing Address - Street 2:STE 110
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3000
Mailing Address - Country:US
Mailing Address - Phone:303-948-1868
Mailing Address - Fax:303-948-1741
Practice Address - Street 1:6169 S BALSAM WAY
Practice Address - Street 2:STE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3062
Practice Address - Country:US
Practice Address - Phone:303-948-1868
Practice Address - Fax:303-948-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4789727261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619905841OtherNPI
1619905841OtherNPI