Provider Demographics
NPI:1679502306
Name:PANTHER PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PANTHER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MENKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-979-5511
Mailing Address - Street 1:5935 S ZANG ST
Mailing Address - Street 2:UNIT 9
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4647
Mailing Address - Country:US
Mailing Address - Phone:303-979-5511
Mailing Address - Fax:303-979-6469
Practice Address - Street 1:5935 S ZANG ST
Practice Address - Street 2:UNIT 9
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4647
Practice Address - Country:US
Practice Address - Phone:303-979-5511
Practice Address - Fax:303-979-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO6272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty