Provider Demographics
NPI:1265049183
Name:METROPOLITAN PHYSICAL THERAPY
Entity type:Organization
Organization Name:METROPOLITAN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CARMELLINI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, MTC
Authorized Official - Phone:303-665-2405
Mailing Address - Street 1:25 CODY ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1240
Mailing Address - Country:US
Mailing Address - Phone:303-665-2405
Mailing Address - Fax:303-648-6602
Practice Address - Street 1:685 BRIGGS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-5022
Practice Address - Country:US
Practice Address - Phone:303-665-2405
Practice Address - Fax:303-648-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000165352Medicaid