Provider Demographics
NPI:1336592500
Name:ABSOLUTE PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:ABSOLUTE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:AMY
Authorized Official - Last Name:SEASHORE BOTHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-387-0255
Mailing Address - Street 1:277 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5742
Mailing Address - Country:US
Mailing Address - Phone:808-387-0255
Mailing Address - Fax:
Practice Address - Street 1:277 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5742
Practice Address - Country:US
Practice Address - Phone:808-387-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty