Provider Demographics
NPI:1730665662
Name:MILE HIGH PHYSICAL THERAPY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MILE HIGH PHYSICAL THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT,OCS
Authorized Official - Phone:973-769-1001
Mailing Address - Street 1:321 CHANGEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9583
Mailing Address - Country:US
Mailing Address - Phone:973-396-8585
Mailing Address - Fax:
Practice Address - Street 1:321 CHANGEBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9583
Practice Address - Country:US
Practice Address - Phone:973-396-8585
Practice Address - Fax:973-396-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty