Provider Demographics
NPI:1245281955
Name:COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL LLC
Entity type:Organization
Organization Name:COLORADO ATHLETIC CONDITIONING CLINIC LOWRY PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDFERN CATALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-567-2400
Mailing Address - Street 1:PO BOX 392977
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-4150
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4068
Practice Address - Street 1:10345 PARKGLENN WAY
Practice Address - Street 2:STE #220
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3869
Practice Address - Country:US
Practice Address - Phone:303-840-9202
Practice Address - Fax:303-840-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC528778Medicare ID - Type Unspecified
COY07668Medicare UPIN