Basic Information
| Provider Information | |||||||||
| NPI: | 1700252731 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONCENTRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5080 SPECTRUM DR | ||||||||
| Address2: | SUITE 1200 WEST | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750014648 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11185 W 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802155538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032396060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2015 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | CROWDER | ||||||||
| AuthorizedOfficialFirstName: | DONITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | TEAM LEAD CREDENITALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 9727256422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PTL-0013479 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.