Provider Demographics
NPI:1457799637
Name:MONARCH PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MONARCH PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-545-6179
Mailing Address - Street 1:6234 OLDE STAGE RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9498
Mailing Address - Country:US
Mailing Address - Phone:720-545-6179
Mailing Address - Fax:866-568-6675
Practice Address - Street 1:6234 OLDE STAGE RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-9498
Practice Address - Country:US
Practice Address - Phone:720-545-6179
Practice Address - Fax:866-568-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO310428YUHFMedicare UPIN