Provider Demographics
NPI:1740537646
Name:COMPETITIVE EDGE PHYSICAL THERAPY AND FITNESS
Entity type:Organization
Organization Name:COMPETITIVE EDGE PHYSICAL THERAPY AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-331-5502
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-0955
Mailing Address - Country:US
Mailing Address - Phone:970-331-5502
Mailing Address - Fax:970-328-5776
Practice Address - Street 1:247 RING NECK
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:970-328-5549
Practice Address - Fax:970-328-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COO9639373Medicaid