Provider Demographics
NPI:1568129740
Name:CPTN PRIME
Entity Type:Organization
Organization Name:CPTN PRIME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ENGLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-757-7004
Mailing Address - Street 1:3333 S WADSWORTH BLVD UNIT 212
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5163
Mailing Address - Country:US
Mailing Address - Phone:303-757-7004
Mailing Address - Fax:303-757-6770
Practice Address - Street 1:489 N US HIGHWAY 287 STE 190
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8905
Practice Address - Country:US
Practice Address - Phone:303-518-0194
Practice Address - Fax:303-604-6358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CPTN PRIME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy