Transformation Therapeutics, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

TRANSFORMATION THERAPEUTICS, PLLC

Practice address

622 Mountain Village Blvd Ste 102
Mountain Village, CO 81435-9529

Phone

(970) 728-7047

Fax

(970) 728-7045

NPI assigned

Nov 14, 2018

Last updated

Nov 20, 2018By 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

Jennifer Bullock, PTNPI 1164907986

Title

Owner

Phone

(214) 864-2440

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 17

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.

• Jennifer Sullivan Bullock, PT, DPT

  • Physical Therapist
  • Mountain Village, CO
  • NPI 1164907986
  Medicare reassignment NPD Authorized official
• Laura J Homer, MPT, OCS

  • Physical Medicine & Rehabilitation Physician
  • Telluride, CO
  • NPI 1093728263
  NPD
• Katrina Rinne, DPT

  • Physical Therapist
  • Telluride, CO
  • NPI 1972981603
  NPD
• Derek C Tuohy, MSPT, CSCS

  • Physical Medicine & Rehabilitation Physician
  • Mountain Village, CO
  • NPI 1134223316
  NPD
• Brandon Tran, DPT

  • Physical Therapist
  • Carlsbad, CA
  • NPI 1790569176
  NPD
• Matt Destefano, DPT

  • Physical Therapist
  • Telluride, CO
  • NPI 1588166532
  NPD (past)
• Julie Graham

  • Occupational Therapist
  • Montrose, CO
  • NPI 1386065381
  NPD (past)
• Brooke Lockard, DPT

  • Physical Therapist
  • Telluride, CO
  • NPI 1114432580
  NPD (past)
• David Malin, PT

  • Physical Therapist
  • Ridgway, CO
  • NPI 1417202482
  NPD (past)
• Grover Olcott Price, PT, DPT

  • Physical Therapist
  • Norwood, CO
  • NPI 1114177052
  NPD (past)
• Kimberly D Schmidt, O.T.

  • Occupational Therapist
  • Olathe, CO
  • NPI 1659437077
  NPD (past)
• Lisa Lynette Sink, PT

  • Physical Therapist
  • Telluride, CO
  • NPI 1952725012
  NPD (past)

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

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542672000000",
    "number": "1679042121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 MOUNTAIN VILLAGE BLVD STE 102",
            "city": "MOUNTAIN VILLAGE",
            "state": "CO",
            "postal_code": "814359529",
            "telephone_number": "970-728-7047",
            "fax_number": "970-728-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 MOUNTAIN VILLAGE BLVD STE 102",
            "city": "MOUNTAIN VILLAGE",
            "state": "CO",
            "postal_code": "814359529",
            "telephone_number": "970-728-7047",
            "fax_number": "970-728-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSFORMATION THERAPEUTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-14",
        "last_updated": "2018-11-20",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-864-2440",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Balanced Therapy LLC
• Jennifer Sullivan Bullock, PT, DPT
• Derek C Tuohy, MSPT, CSCS

• Physical Therapy Clinic/Center in Mountain Village, CO
• Providers in Mountain Village, 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 Nov 20, 2018; 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.