Provider Demographics
NPI:1700169745
Name:LODO PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:LODO PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-912-9220
Mailing Address - Street 1:1401 17TH ST
Mailing Address - Street 2:SUITE 475
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1268
Mailing Address - Country:US
Mailing Address - Phone:303-913-6516
Mailing Address - Fax:303-412-0645
Practice Address - Street 1:1401 17TH ST
Practice Address - Street 2:SUITE 475
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1268
Practice Address - Country:US
Practice Address - Phone:303-913-6516
Practice Address - Fax:303-412-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7838225100000X, 2251E1200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639128374OtherNPI
11604678OtherCAQH PROVIDER #
COC463148Medicare PIN