Provider Demographics
NPI:1700613973
Name:MOUNTAIN TIME PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:MOUNTAIN TIME PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SLIFKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-760-0535
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:LA VETA
Mailing Address - State:CO
Mailing Address - Zip Code:81055-0548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 W RYUS AVE
Practice Address - Street 2:
Practice Address - City:LA VETA
Practice Address - State:CO
Practice Address - Zip Code:81055
Practice Address - Country:US
Practice Address - Phone:412-760-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty