Provider Demographics
NPI:1457382624
Name:POLESTAR PILATES CENTER DENVER LLC
Entity type:Organization
Organization Name:POLESTAR PILATES CENTER DENVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-322-9688
Mailing Address - Street 1:3773 CHERRY CREEK NORTH DR
Mailing Address - Street 2:720
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3817
Mailing Address - Country:US
Mailing Address - Phone:303-322-9294
Mailing Address - Fax:303-322-9688
Practice Address - Street 1:3773 CHERRY CREEK NORTH DR
Practice Address - Street 2:720
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3817
Practice Address - Country:US
Practice Address - Phone:303-322-9294
Practice Address - Fax:303-322-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804849Medicare PIN