Provider Demographics
NPI:1750928495
Name:BUILD SPORTS PERFORMANCE LAB AND PHYSICAL THERAPY
Entity type:Organization
Organization Name:BUILD SPORTS PERFORMANCE LAB AND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-710-8136
Mailing Address - Street 1:625 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1893
Mailing Address - Country:US
Mailing Address - Phone:720-710-8136
Mailing Address - Fax:
Practice Address - Street 1:625 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1893
Practice Address - Country:US
Practice Address - Phone:720-710-8136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty