Provider Demographics
NPI:1952414237
Name:DORSA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DORSA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:DORSA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:970-945-1467
Mailing Address - Street 1:214 8TH STREET
Mailing Address - Street 2:SUITE 306
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3326
Mailing Address - Country:US
Mailing Address - Phone:970-945-1467
Mailing Address - Fax:970-945-1392
Practice Address - Street 1:214 8TH STREET
Practice Address - Street 2:SUITE 306
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3326
Practice Address - Country:US
Practice Address - Phone:970-945-1467
Practice Address - Fax:970-945-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4743261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
C547158Medicare PIN