Basic Information
| Provider Information | |||||||||
| NPI: | 1669570016 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPORT AND SPINE PT, BRIGHTON, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2418 E BRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806012546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036558699 | ||||||||
| FaxNumber: | 3036558698 | ||||||||
| Practice Location | |||||||||
| Address1: | 2418 E BRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806012546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036558699 | ||||||||
| FaxNumber: | 3036558698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 03/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZYLSTRA | ||||||||
| AuthorizedOfficialFirstName: | EDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3036558699 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.