Basic Information
| Provider Information | |||||||||
| NPI: | 1730795725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXOS PHYSICAL THERAPY AND SPORTS MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2629 E ROSE GARDEN LN | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850504605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708850965 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12482 W KEN CARYL AVE UNIT A4 | ||||||||
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| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801273724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205450486 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2020 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | PERRY | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9013559400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.