Provider Demographics
NPI:1235950387
Name:IRON IMPACT PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:IRON IMPACT PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:502-671-9325
Mailing Address - Street 1:143 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223
Mailing Address - Country:US
Mailing Address - Phone:502-671-9325
Mailing Address - Fax:
Practice Address - Street 1:143 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223
Practice Address - Country:US
Practice Address - Phone:502-671-9325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy