Provider Demographics
NPI:1740238120
Name:COAL CREEK PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:COAL CREEK PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BYRT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:720-891-0532
Mailing Address - Street 1:315 W SOUTH BOULDER RD
Mailing Address - Street 2:STE. # 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1156
Mailing Address - Country:US
Mailing Address - Phone:303-666-4151
Mailing Address - Fax:303-666-4166
Practice Address - Street 1:315 W SOUTH BOULDER RD
Practice Address - Street 2:STE. # 100
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1156
Practice Address - Country:US
Practice Address - Phone:303-666-4151
Practice Address - Fax:303-666-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC445418Medicare PIN