Basic Information
| Provider Information | |||||||||
| NPI: | 1093877565 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERFORMAX FRONT RANGE PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5920 S ESTES ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801238618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039322500 | ||||||||
| FaxNumber: | 3039322600 | ||||||||
| Practice Location | |||||||||
| Address1: | 7600 E EASTMAN AVE | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802314376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7207477788 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TEIXEIRA | ||||||||
| AuthorizedOfficialFirstName: | JOSPEH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3039322500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.