Thomas Kenneth Backe, PT, DPT, CLT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4430 Issued in NH

Practice address

16420 W US Highway 24
Woodland Park, CO 80863-8760

Phone

(719) 374-6172

Fax

(719) 374-6118

NPI assigned

Sep 24, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1437633658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16420 W US HIGHWAY 24",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808638760",
            "telephone_number": "719-374-6172",
            "fax_number": "719-374-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16420 W US HIGHWAY 24",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808638760",
            "telephone_number": "719-374-6172",
            "fax_number": "719-374-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACKE",
        "first_name": "THOMAS",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, CLT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-24",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0015815",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305212280",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NH",
            "license": "4430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Woodland Park, CO
• Providers in Woodland Park, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.