Provider Demographics
NPI:1770092942
Name:DEGRANDIS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:DEGRANDIS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGRANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CFMT
Authorized Official - Phone:440-213-0909
Mailing Address - Street 1:817 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1905
Mailing Address - Country:US
Mailing Address - Phone:440-213-0909
Mailing Address - Fax:
Practice Address - Street 1:777 29TH ST STE 401
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2316
Practice Address - Country:US
Practice Address - Phone:440-213-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0012652261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy