Provider Demographics
NPI:1730519695
Name:SPINAL THERAPY LLC
Entity type:Organization
Organization Name:SPINAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DC
Authorized Official - Phone:702-400-6916
Mailing Address - Street 1:13918 E MISSISSIPPI AVE
Mailing Address - Street 2:#337
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7800 E ORCHARD RD
Practice Address - Street 2:SUITE 350
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2583
Practice Address - Country:US
Practice Address - Phone:303-741-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL5729261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy