Provider Demographics
NPI:1669351805
Name:HEADWATERS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:HEADWATERS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:720-812-3583
Mailing Address - Street 1:802 SUMMER DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-3092
Mailing Address - Country:US
Mailing Address - Phone:317-407-0862
Mailing Address - Fax:
Practice Address - Street 1:1 DELWOOD DR UNIT 640
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-2421
Practice Address - Country:US
Practice Address - Phone:720-812-3583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty