Provider Demographics
NPI:1710026992
Name:VILLAGE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:VILLAGE PHYSICAL THERAPY, PC
Other - Org Name:PT SOLUTIONS OF COLORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-981-3543
Mailing Address - Street 1:545 E PIKES PEAK AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3637
Mailing Address - Country:US
Mailing Address - Phone:719-577-4104
Mailing Address - Fax:719-575-0872
Practice Address - Street 1:5825 DELMONICO DR STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2244
Practice Address - Country:US
Practice Address - Phone:719-577-4104
Practice Address - Fax:719-575-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC20353Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER