Provider Demographics
NPI:1770530206
Name:SOUTHLANDS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SOUTHLANDS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PT MS
Authorized Official - Phone:303-884-1946
Mailing Address - Street 1:24743 E QUARTO PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-7168
Mailing Address - Country:US
Mailing Address - Phone:303-884-1946
Mailing Address - Fax:720-862-0075
Practice Address - Street 1:24743 E QUARTO PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-7168
Practice Address - Country:US
Practice Address - Phone:303-884-1946
Practice Address - Fax:720-862-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy