Provider Demographics
NPI:1801849641
Name:EVERGREEN PHYSICAL THERAPY SPECIALISTS, PC
Entity Type:Organization
Organization Name:EVERGREEN PHYSICAL THERAPY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-674-1594
Mailing Address - Street 1:30940 STAGECOACH BLVD
Mailing Address - Street 2:SUITE E110
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7984
Mailing Address - Country:US
Mailing Address - Phone:303-674-1594
Mailing Address - Fax:
Practice Address - Street 1:30940 STAGECOACH BLVD
Practice Address - Street 2:SUITE E110
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439
Practice Address - Country:US
Practice Address - Phone:303-674-1594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802487Medicare ID - Type Unspecified
COC80247Medicare PIN