Provider Demographics
NPI:1720386543
Name:TAKE A WALK THERAPY LLC
Entity Type:Organization
Organization Name:TAKE A WALK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-690-8004
Mailing Address - Street 1:5123 SNEAD CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9197
Mailing Address - Country:US
Mailing Address - Phone:970-690-8004
Mailing Address - Fax:
Practice Address - Street 1:5300 29TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8399
Practice Address - Country:US
Practice Address - Phone:970-690-8004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8089225100000X
CO1209225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty