Provider Demographics
NPI:1548796113
Name:A PERSONALIZED PHYSICAL THERAPIST LLC
Entity Type:Organization
Organization Name:A PERSONALIZED PHYSICAL THERAPIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:720-448-6820
Mailing Address - Street 1:19433 E MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3874
Mailing Address - Country:US
Mailing Address - Phone:720-810-3743
Mailing Address - Fax:720-446-3523
Practice Address - Street 1:19433 E MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-3874
Practice Address - Country:US
Practice Address - Phone:720-810-3743
Practice Address - Fax:720-446-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty