Provider Demographics
NPI:1558315044
Name:DENVER PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:DENVER PHYSICAL THERAPY, P.C.
Other - Org Name:PRO ACTIVE PHYSICAL THERAPY CASTLE ROCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-804-1712
Mailing Address - Street 1:7310 S ALTON WAY
Mailing Address - Street 2:STE 6L
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2334
Mailing Address - Country:US
Mailing Address - Phone:303-790-4495
Mailing Address - Fax:720-488-1988
Practice Address - Street 1:900 CASTLETON RD
Practice Address - Street 2:#100
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-7552
Practice Address - Country:US
Practice Address - Phone:303-688-3914
Practice Address - Fax:303-688-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN0503OtherANTHEM BLUE CROSS/SHIELD
CO=========80204OtherTRICARE
CON0503Medicare PIN