Provider Demographics
NPI:1639582430
Name:DOVICO PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:DOVICO PHYSICAL THERAPY, LLC
Other - Org Name:DPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVICO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-220-7767
Mailing Address - Street 1:8130 S UNIVERSITY BLVD
Mailing Address - Street 2:STE 135
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-5106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8130 S UNIVERSITY BLVD
Practice Address - Street 2:STE 135
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-5106
Practice Address - Country:US
Practice Address - Phone:480-220-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11595261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy