Sundance Therapy, LLC

Primary specialty

Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X

License

OT.0000937 Issued in CO

Legal business name

SUNDANCE THERAPY, LLC

Practice address

2088 Woodpecker LN
Elizabeth, CO 80107-8558

Phone

(601) 493-6968

NPI assigned

Dec 16, 2016

Last updated

Nov 15, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jeffrey P Galloway, OTRNPI 1548501075

Title

Occupational Therapist/ Owner

Phone

(601) 493-6968

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Galloway

  • Occupational Therapist
  • Elizabeth, CO
  • NPI 1548501075
  Medicare reassignment NPD Authorized official
• Autumn Lea Muckenhirn

  • Speech-Language Pathologist
  • Elizabeth, CO
  • NPI 1932888476
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636934400000",
    "number": "1033653670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2088 WOODPECKER LN",
            "city": "ELIZABETH",
            "state": "CO",
            "postal_code": "801078558",
            "telephone_number": "601-493-6968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2088 WOODPECKER LN",
            "city": "ELIZABETH",
            "state": "CO",
            "postal_code": "801078558",
            "telephone_number": "601-493-6968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-16",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A",
        "authorized_official_last_name": "GALLOWAY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST/ OWNER",
        "authorized_official_telephone_number": "601-493-6968",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CO",
            "license": "OTA.0000647",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "CO",
            "license": "OT.0000937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Rehabilitation Occupational Therapist in Elizabeth, CO
• Providers in Elizabeth, CO by specialty
• Physical Rehabilitation Occupational Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.