Provider Demographics
NPI:1689801698
Name:ADVANCED PHYSICAL AND SPORTS THERAPY, LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL AND SPORTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKENKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-733-3655
Mailing Address - Street 1:880 W HAPPY CANYON RD STE 145
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3915
Mailing Address - Country:US
Mailing Address - Phone:720-733-3655
Mailing Address - Fax:720-733-3656
Practice Address - Street 1:880 W HAPPY CANYON RD STE 145
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3915
Practice Address - Country:US
Practice Address - Phone:720-733-3655
Practice Address - Fax:720-733-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty