Organization
CENTURA VENTURES, LLC
Active
Other names
Colorado Sport and Spine Centers, XCS PT BROADMOOR, Centura Physical Therapy at Broadmoor
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA CARPENTER RN (VP, AMBULATORY SERVICES)
(303) 765-6998
Entity
Organization
Contact information
Practice address
1263 LAKE PLAZA DR STE 210B, COLORADO SPRINGS, CO 80906-3564
(719) 776-3350
(719) 776-3374
Mailing address
PO BOX 801172, KANSAS CITY, MO 64180-1172
(800) 953-0104
(303) 765-6670
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073882197
OLD NPI
—
05
—
9000146144
—
CO
Enumeration date
02/06/2020
Last updated
12/21/2020
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