Basic Information
| Provider Information | |||||||||
| NPI: | 1558315044 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENVER PHYSICAL THERAPY, P.C. | ||||||||
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| OtherOrganizationName: | PRO ACTIVE PHYSICAL THERAPY CASTLE ROCK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7310 S ALTON WAY | ||||||||
| Address2: | STE 6L | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801122334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037904495 | ||||||||
| FaxNumber: | 7204881988 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 CASTLETON RD | ||||||||
| Address2: | #100 | ||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801097552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036883914 | ||||||||
| FaxNumber: | 3036884499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | PACE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 2138041712 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | DEN0503 | 01 | CO | ANTHEM BLUE CROSS/SHIELD | OTHER |