Provider Demographics
NPI: | 1740703081 |
---|---|
Name: | ALTIUS PHYSICAL THERAPY AND WELLNESS |
Entity type: | Organization |
Organization Name: | ALTIUS PHYSICAL THERAPY AND WELLNESS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SARAH |
Authorized Official - Middle Name: | KRISTINE |
Authorized Official - Last Name: | ELLEFSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT, DPT, OCS |
Authorized Official - Phone: | 970-343-4688 |
Mailing Address - Street 1: | PO BOX 768 |
Mailing Address - Street 2: | |
Mailing Address - City: | AVON |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 81620-0768 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 970-343-4688 |
Mailing Address - Fax: | 970-360-2337 |
Practice Address - Street 1: | 160 W BEAVER CREEK BLVD |
Practice Address - Street 2: | |
Practice Address - City: | AVON |
Practice Address - State: | CO |
Practice Address - Zip Code: | 81620-5422 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-343-4688 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-07-19 |
Last Update Date: | 2022-12-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |