Provider Demographics
NPI:1053362285
Name:PINNACLE PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-502-4450
Mailing Address - Street 1:4266 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1636
Mailing Address - Country:US
Mailing Address - Phone:303-502-4450
Mailing Address - Fax:303-440-7242
Practice Address - Street 1:1449 LODGE LN UNIT B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-8104
Practice Address - Country:US
Practice Address - Phone:303-502-4450
Practice Address - Fax:303-440-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1373174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC500538OtherPTAN
CO1373OtherLICENSE