Provider Demographics
NPI:1710643044
Name:HOMEFIT THERAPY COLORADO LLC
Entity Type:Organization
Organization Name:HOMEFIT THERAPY COLORADO LLC
Other - Org Name:COLORADO HOMEFITTERS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:817-992-1495
Mailing Address - Street 1:6155 FOUNTAIN VALLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-2251
Mailing Address - Country:US
Mailing Address - Phone:817-992-1495
Mailing Address - Fax:
Practice Address - Street 1:6155 FOUNTAIN VALLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2251
Practice Address - Country:US
Practice Address - Phone:817-992-1495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty