Provider Demographics
NPI:1548289838
Name:ONE80 PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:ONE80 PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:E
Authorized Official - Last Name:POLKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:970-593-9300
Mailing Address - Street 1:1694 TOPAZ DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3210
Mailing Address - Country:US
Mailing Address - Phone:970-593-9300
Mailing Address - Fax:970-593-9318
Practice Address - Street 1:1694 TOPAZ DRIVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3210
Practice Address - Country:US
Practice Address - Phone:970-593-9300
Practice Address - Fax:970-593-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804993Medicare PIN