Basic Information
| Provider Information | |||||||||
| NPI: | 1265686224 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FIT PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6612 S WARD ST | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801274855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034092133 | ||||||||
| FaxNumber: | 3034092233 | ||||||||
| Practice Location | |||||||||
| Address1: | 6612 S WARD ST | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801274855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034092133 | ||||||||
| FaxNumber: | 3034092233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2008 | ||||||||
| LastUpdateDate: | 10/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | COSTELLO | ||||||||
| AuthorizedOfficialFirstName: | PATTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3034092133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8415 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 660925 | 01 | CO | BCBS | OTHER |