Provider Demographics
| NPI: | 1588622567 |
|---|---|
| Name: | MOUNTAIN STATES HAND AND PHYSICAL THERAPY, INC. |
| Entity Type: | Organization |
| Organization Name: | MOUNTAIN STATES HAND AND PHYSICAL THERAPY, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PARTNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SHEILA |
| Authorized Official - Middle Name: | JANAE |
| Authorized Official - Last Name: | MORTON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | OTR, CHT |
| Authorized Official - Phone: | 303-953-3163 |
| Mailing Address - Street 1: | 4045 WADSWORTH BLVD STE 210 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WHEAT RIDGE |
| Mailing Address - State: | CO |
| Mailing Address - Zip Code: | 80033-4624 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 303-953-3163 |
| Mailing Address - Fax: | 303-245-0726 |
| Practice Address - Street 1: | 4045 WADSWORTH BLVD STE 210 |
| Practice Address - Street 2: | |
| Practice Address - City: | WHEAT RIDGE |
| Practice Address - State: | CO |
| Practice Address - Zip Code: | 80033-4624 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 303-953-3163 |
| Practice Address - Fax: | 303-245-0726 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-01 |
| Last Update Date: | 2021-01-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Single Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Single Specialty |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Single Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |
| No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Single Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
| No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Single Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Single Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CO | C805564 | Medicare PIN |
