Provider Demographics
NPI:1134433089
Name:PROFESSIONAL TOUCH PT, LLC
Entity type:Organization
Organization Name:PROFESSIONAL TOUCH PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:COOLIDGE
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:970-218-3529
Mailing Address - Street 1:2144 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8402
Mailing Address - Country:US
Mailing Address - Phone:303-678-7170
Mailing Address - Fax:303-678-7134
Practice Address - Street 1:2144 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8402
Practice Address - Country:US
Practice Address - Phone:303-678-7170
Practice Address - Fax:303-678-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-10363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty