Provider Demographics
NPI:1538603519
Name:INNOVATIVE PHYSICAL THERAPY
Entity type:Organization
Organization Name:INNOVATIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELILAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-424-7243
Mailing Address - Street 1:4704 HARLAN ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7415
Mailing Address - Country:US
Mailing Address - Phone:303-424-7243
Mailing Address - Fax:303-421-0705
Practice Address - Street 1:4704 HARLAN ST
Practice Address - Street 2:SUITE 505
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7415
Practice Address - Country:US
Practice Address - Phone:303-424-7243
Practice Address - Fax:303-421-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL9777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13135163Medicaid