Provider Demographics
NPI:1215056023
Name:PHYSICAL THERAPY OF BOULDER
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF BOULDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LEN
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:303-938-1141
Mailing Address - Street 1:3020 CARBON PL STE 330
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-6148
Mailing Address - Country:US
Mailing Address - Phone:303-938-1141
Mailing Address - Fax:303-938-1311
Practice Address - Street 1:3020 CARBON PL STE 330
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-6148
Practice Address - Country:US
Practice Address - Phone:303-938-1141
Practice Address - Fax:303-938-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC444998Medicare PIN