Provider Demographics
NPI:1720128028
Name:SPORTS PHYSICAL THERAPY AND PILATES INC
Entity Type:Organization
Organization Name:SPORTS PHYSICAL THERAPY AND PILATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-920-1070
Mailing Address - Street 1:STE A
Mailing Address - Street 2:303 ASPEN BUSINESS CTR
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-3500
Mailing Address - Country:US
Mailing Address - Phone:970-920-1070
Mailing Address - Fax:970-920-1071
Practice Address - Street 1:STE A
Practice Address - Street 2:303 ASPEN BUSINESS CTR
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-3500
Practice Address - Country:US
Practice Address - Phone:970-920-1070
Practice Address - Fax:970-920-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807530Medicare PIN