Provider Demographics
NPI:1760868319
Name:CRESTED BUTTE PHYSIOTHERAPY, PC
Entity Type:Organization
Organization Name:CRESTED BUTTE PHYSIOTHERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-596-0422
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1014
Mailing Address - Country:US
Mailing Address - Phone:970-349-2817
Mailing Address - Fax:
Practice Address - Street 1:505 2ND ST
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-349-2817
Practice Address - Fax:970-349-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8225261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy