Provider Demographics
NPI:1851699144
Name:HOMETOWN PHYSICAL THERAPY AND MASSAGE PC
Entity Type:Organization
Organization Name:HOMETOWN PHYSICAL THERAPY AND MASSAGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O./PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURTAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:970-532-7500
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:516 MOUNTAIN AVE
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-1848
Mailing Address - Country:US
Mailing Address - Phone:970-532-7500
Mailing Address - Fax:970-532-7510
Practice Address - Street 1:516 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513
Practice Address - Country:US
Practice Address - Phone:970-532-7500
Practice Address - Fax:970-532-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty