Provider Demographics
NPI:1730276171
Name:PARK MEADOWS PHYSICAL THERAPY
Entity type:Organization
Organization Name:PARK MEADOWS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-680-6121
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:720-344-7034
Mailing Address - Fax:720-344-7032
Practice Address - Street 1:8671 S QUEBEC ST STE 130
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-5860
Practice Address - Country:US
Practice Address - Phone:720-344-7034
Practice Address - Fax:720-344-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty