Provider Demographics
NPI:1881883510
Name:DANCE OF LIFE FAMILY PRACTICE & PHYSICAL MEDICINE, P.C.
Entity type:Organization
Organization Name:DANCE OF LIFE FAMILY PRACTICE & PHYSICAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LETZT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-507-8815
Mailing Address - Street 1:4950 S YOSEMITE ST
Mailing Address - Street 2:SUITE # F2-170
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1349
Mailing Address - Country:US
Mailing Address - Phone:303-507-8815
Mailing Address - Fax:
Practice Address - Street 1:7120 E HAMPDEN AVE
Practice Address - Street 2:STE. B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3048
Practice Address - Country:US
Practice Address - Phone:303-507-8815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2009-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty