Provider Demographics
NPI:1760502496
Name:OCCUPATIONAL PHYSICAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:OCCUPATIONAL PHYSICAL THERAPY ASSOCIATES
Other - Org Name:EXCEL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-390-7010
Mailing Address - Street 1:3002 S ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3202
Mailing Address - Country:US
Mailing Address - Phone:719-390-7010
Mailing Address - Fax:719-390-8848
Practice Address - Street 1:3002 S ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-3202
Practice Address - Country:US
Practice Address - Phone:719-390-7010
Practice Address - Fax:719-390-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty