Provider Demographics
NPI:1013118348
Name:CLEAR CREEK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CLEAR CREEK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-423-3008
Mailing Address - Street 1:8250 W 80TH AVE
Mailing Address - Street 2:UNIT 12
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-5031
Mailing Address - Country:US
Mailing Address - Phone:303-423-3008
Mailing Address - Fax:303-423-3011
Practice Address - Street 1:8250 W 80TH AVE
Practice Address - Street 2:UNIT 12
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-5031
Practice Address - Country:US
Practice Address - Phone:303-423-3008
Practice Address - Fax:303-423-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3208261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800965Medicare PIN