Provider Demographics
NPI:1619560794
Name:ANEWU PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ANEWU PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOTSCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-307-1199
Mailing Address - Street 1:209 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4228
Mailing Address - Country:US
Mailing Address - Phone:408-307-1199
Mailing Address - Fax:
Practice Address - Street 1:2995 BASELINE RD STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2318
Practice Address - Country:US
Practice Address - Phone:970-480-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy