Provider Demographics
NPI:1649229089
Name:PHYSICAL THERAPY & INDUSTRIAL SERVICES PC
Entity type:Organization
Organization Name:PHYSICAL THERAPY & INDUSTRIAL SERVICES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-757-1554
Mailing Address - Street 1:3601 S PEARL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3805
Mailing Address - Country:US
Mailing Address - Phone:303-757-1554
Mailing Address - Fax:303-757-3104
Practice Address - Street 1:3601 S PEARL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3805
Practice Address - Country:US
Practice Address - Phone:303-757-1554
Practice Address - Fax:303-757-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2357174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCK5523Medicare UPIN