Provider Demographics
NPI:1205474657
Name:ANTHEM PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ANTHEM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CERT DN
Authorized Official - Phone:719-645-5052
Mailing Address - Street 1:10083 MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7040
Mailing Address - Country:US
Mailing Address - Phone:719-645-5052
Mailing Address - Fax:720-419-3297
Practice Address - Street 1:1826 E PLATTE AVE STE 114
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5738
Practice Address - Country:US
Practice Address - Phone:719-645-5052
Practice Address - Fax:720-419-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000180490Medicaid