Basic Information
Provider Information
NPI: 1104895754
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: 7179721100
FaxNumber: 7179759781
Practice Location
Address1: 255 UNION BLVD
Address2: STE 110
City: LAKEWOOD
State: CO
PostalCode: 80228
CountryCode: US
TelephoneNumber: 3032320355
FaxNumber: 3032320411
Other Information
ProviderEnumerationDate: 03/16/2006
LastUpdateDate: 09/01/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate: 12/07/2007
NPIReactivationDate: 02/06/2008
ProviderGenderCode:  
AuthorizedOfficialLastName: TARVIN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: E
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 7179721100
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2000X CON Ambulatory Health Care FacilitiesClinic/CenterPhysical Therapy
261QR0400X  Y Ambulatory Health Care FacilitiesClinic/CenterRehabilitation

No ID Information.


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