Basic Information
| Provider Information | |||||||||
| NPI: | 1154939080 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VAIL SUMMIT PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1303 | ||||||||
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| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804431303 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 PEAK ONE DR STE 190 | ||||||||
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| City: | FRISCO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804435868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706680888 | ||||||||
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| ProviderEnumerationDate: | 07/16/2020 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | THOMASON | ||||||||
| AuthorizedOfficialFirstName: | CARI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9702410202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
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.