Provider Demographics
NPI:1053784686
Name:VITAL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:VITAL PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:702-519-1548
Mailing Address - Street 1:12211 W ALAMEDA PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2866
Mailing Address - Country:US
Mailing Address - Phone:720-519-1548
Mailing Address - Fax:
Practice Address - Street 1:12211 W ALAMEDA PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2866
Practice Address - Country:US
Practice Address - Phone:720-519-1548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty