Provider Demographics
NPI:1811260557
Name:SELECT PHYSICAL THERAPY
Entity type:Organization
Organization Name:SELECT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER MANAGER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-798-5602
Mailing Address - Street 1:151 W MINERAL AVE
Mailing Address - Street 2:SUITE 116A
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5611
Mailing Address - Country:US
Mailing Address - Phone:303-798-5602
Mailing Address - Fax:
Practice Address - Street 1:151 W MINERAL AVE
Practice Address - Street 2:SUITE 116A
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5611
Practice Address - Country:US
Practice Address - Phone:303-798-5602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELECT MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11970261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066561Medicare PIN