Provider Demographics
NPI:1528534740
Name:11-11 PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:11-11 PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-471-6212
Mailing Address - Street 1:6851 S HOLLY CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1040
Mailing Address - Country:US
Mailing Address - Phone:303-771-3745
Mailing Address - Fax:303-771-3728
Practice Address - Street 1:6851 S HOLLY CIR STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1040
Practice Address - Country:US
Practice Address - Phone:303-771-3745
Practice Address - Fax:303-771-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy