Provider Demographics
NPI:1770669046
Name:PACE THERAPY PC
Entity Type:Organization
Organization Name:PACE THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:303-546-9201
Mailing Address - Street 1:1800 30TH STREET SUITE 215
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1026
Mailing Address - Country:US
Mailing Address - Phone:303-546-9201
Mailing Address - Fax:303-545-5080
Practice Address - Street 1:1800 30TH STREET SUITE 215
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1026
Practice Address - Country:US
Practice Address - Phone:303-546-9201
Practice Address - Fax:303-545-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
470998Medicare ID - Type Unspecified