Provider Demographics
NPI:1952571127
Name:ANTOS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ANTOS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:970-274-1293
Mailing Address - Street 1:PO BOX 4504
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81612-4504
Mailing Address - Country:US
Mailing Address - Phone:970-274-1293
Mailing Address - Fax:970-544-0775
Practice Address - Street 1:333 E DURANT AVE
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1839
Practice Address - Country:US
Practice Address - Phone:970-274-1293
Practice Address - Fax:970-544-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6178261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803948Medicare PIN