Provider Demographics
NPI:1881307296
Name:WINGS PHYSICAL THERAPY COMPANY LLC
Entity type:Organization
Organization Name:WINGS PHYSICAL THERAPY COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEYMUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZOYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-839-4542
Mailing Address - Street 1:297 N US HIGHWAY 287 STE 105
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8953
Mailing Address - Country:US
Mailing Address - Phone:718-839-4542
Mailing Address - Fax:
Practice Address - Street 1:297 N US HIGHWAY 287 STE 105
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8953
Practice Address - Country:US
Practice Address - Phone:718-839-4542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty