Provider Demographics
NPI:1992825202
Name:VILLAGE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:VILLAGE PHYSICAL THERAPY, PC
Other - Org Name:PT SOLUTIONS OF COLORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-837-7176
Mailing Address - Street 1:PO BOX 200880
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0880
Mailing Address - Country:US
Mailing Address - Phone:678-837-7176
Mailing Address - Fax:404-777-1311
Practice Address - Street 1:1209 PASEO DEL NORTE STE 3
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2083
Practice Address - Country:US
Practice Address - Phone:719-569-5691
Practice Address - Fax:719-569-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1497225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC20353Medicare ID - Type UnspecifiedPROVIDER NUMBER