Provider Demographics
NPI:1881776748
Name:MOUNTAIN VALLEY PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:MOUNTAIN VALLEY PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOLD
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:303-888-2993
Mailing Address - Street 1:910 S DEXTER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2605
Mailing Address - Country:US
Mailing Address - Phone:303-758-6878
Mailing Address - Fax:303-757-6859
Practice Address - Street 1:910 S DEXTER ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2605
Practice Address - Country:US
Practice Address - Phone:303-758-6878
Practice Address - Fax:303-757-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty