Provider Demographics
NPI:1184622409
Name:PHYSICAL THERAPY PLUS, INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY PLUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:719-336-4364
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-0447
Mailing Address - Country:US
Mailing Address - Phone:719-336-4364
Mailing Address - Fax:719-336-4365
Practice Address - Street 1:6935 US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-9584
Practice Address - Country:US
Practice Address - Phone:719-336-4364
Practice Address - Fax:719-336-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC536288Medicare PIN