Provider Demographics
NPI:1609255983
Name:PROFESSIONAL SPORTS HEALTH LLC
Entity Type:Organization
Organization Name:PROFESSIONAL SPORTS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HYO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-720-0603
Mailing Address - Street 1:6030 GREENWOOD PLAZA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:303-770-4184
Practice Address - Street 1:6030 GREENWOOD PLAZA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4825
Practice Address - Country:US
Practice Address - Phone:303-720-0603
Practice Address - Fax:303-770-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7946261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy