Basic Information
| Provider Information | |||||||||
| NPI: | 1821000415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACTIVE MOTION PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3865 CHERRY CREEK NORTH DR | ||||||||
| Address2: | LL70 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802093803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033943356 | ||||||||
| FaxNumber: | 3033943359 | ||||||||
| Practice Location | |||||||||
| Address1: | 3865 CHERRY CREEK NORTH DR | ||||||||
| Address2: | LL70 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802093803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033943356 | ||||||||
| FaxNumber: | 3033943359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEVY | ||||||||
| AuthorizedOfficialFirstName: | DERICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/ PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3033943356 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3349 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.