Provider Demographics
NPI:1598090771
Name:PHYSIOCARE
Entity Type:Organization
Organization Name:PHYSIOCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-533-1000
Mailing Address - Street 1:3425 AUSTIN BLUFFS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5701
Mailing Address - Country:US
Mailing Address - Phone:719-533-1000
Mailing Address - Fax:
Practice Address - Street 1:3425 AUSTIN BLUFFS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5701
Practice Address - Country:US
Practice Address - Phone:719-533-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty