Basic Information
Provider Information
NPI: 1467069062
EntityType: 2
ReplacementNPI:  
OrganizationName: SELECT PHYSICAL THERAPY OF WEST DENVER LIMITED PARTNERSHIP
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Mailing Information
Address1: 4714 GETTYSBURG RD
Address2:  
City: MECHANICSBURG
State: PA
PostalCode: 170554325
CountryCode: US
TelephoneNumber:  
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Practice Location
Address1: 3880 GRANT AVE STE 100
Address2:  
City: LOVELAND
State: CO
PostalCode: 805388433
CountryCode: US
TelephoneNumber: 9703529022
FaxNumber: 9073529048
Other Information
ProviderEnumerationDate: 09/28/2020
LastUpdateDate: 09/28/2020
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: TARVIN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 7179721100
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 09/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR0400X  Y Ambulatory Health Care FacilitiesClinic/CenterRehabilitation

No ID Information.


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