Phenom Sports and Rehabilitation

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PHENOM SPORTS AND REHABILITATION

Practice address

10050 Ralston Rd Unit 7
Arvada, CO 80004-4982

Phone

(929) 340-1606

NPI assigned

Feb 22, 2022

Organization subpart

No

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

Authorized official

Name

Mark DavydovNPI 1639595192

Title

Owner

Phone

(720) 415-3376

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Davydov, DPT

  • Physical Therapist
  • Arvada, CO
  • NPI 1639595192
  Medicare reassignment NPD Authorized official
• Ellie Titarenko, NP

  • Adult Health Nurse Practitioner
  • Arvada, CO
  • NPI 1164801841
  NPD
• Emily Neal, DPT

  • Physical Therapist
  • Monroe, MI
  • NPI 1154848091
  NPD

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

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787270400000",
    "number": "1427704170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10050 RALSTON RD UNIT 7",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800044982",
            "telephone_number": "720-415-3376",
            "fax_number": "720-596-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10050 RALSTON RD UNIT 7",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800044982",
            "telephone_number": "929-340-1606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4655 Yampa St Unit 120",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802497689",
            "country_code": "US",
            "telephone_number": "720-415-3376",
            "fax_number": "720-596-5203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHENOM SPORTS AND REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-22",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A",
        "authorized_official_last_name": "DAVYDOV",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-415-3376"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Petzold, M.A., BCBA
• Heidi Rebecca Peveto, B.S.
• Liza Emily Pfaff, D.V.M
• Chau Phan Backlund, PHARMD.
• Christian Jason Phares, RBT
• Amanda Brooke Phillips, MA-MCHS
• Ryan E Phillips, ND, MPH, BCB, NMIT
• Philrho Medical Co PLLC
• Physical Therapy Professionals Inc
• Jonathan Piccirillo, PA

• Physical Therapy Clinic/Center in Arvada, CO
• Providers in Arvada, CO by specialty
• Physical Therapy Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; 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.