Provider Demographics
NPI:1447449921
Name:RIVERGATE PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:RIVERGATE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-259-2547
Mailing Address - Street 1:575 RIVERGATE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7487
Mailing Address - Country:US
Mailing Address - Phone:970-259-2547
Mailing Address - Fax:970-259-9653
Practice Address - Street 1:575 RIVERGATE
Practice Address - Street 2:SUITE 208
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-259-2547
Practice Address - Fax:970-259-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO260503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty