Provider Demographics
NPI:1023634763
Name:CATALYST PHYSICAL THERAPY AND WELLNESS, INC
Entity type:Organization
Organization Name:CATALYST PHYSICAL THERAPY AND WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:858-752-8423
Mailing Address - Street 1:16542 PROSPECT LN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4606
Mailing Address - Country:US
Mailing Address - Phone:858-752-8473
Mailing Address - Fax:
Practice Address - Street 1:16542 PROSPECT LN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-4606
Practice Address - Country:US
Practice Address - Phone:858-752-8473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty