Organization
PHYSICAL THERAPY CENTER, INC.
Active
Other names
Patricia Vickland
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM RIVERA (OFFICE MANAGER)
(303) 776-0333
Entity
Organization
Contact information
Practice address
1330 SUNSET ST, LONGMONT, CO 80501-3218
(303) 776-0333
(303) 776-0107
Mailing address
1330 SUNSET ST, LONGMONT, CO 80501-3218
(303) 776-0333
(303) 776-0107
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2550
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193624
DEPT. OF LABOR - WASHINGT
CO
01
—
4915543
CIGNA PIN#
CO
01
—
PH654911
ANTHEM BLUE CROSS/SHIELD
CO
Enumeration date
11/10/2006
Last updated
02/19/2008
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