Basic Information
Provider Information | |||||||||
NPI: | 1427630920 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ACCELERATED REHAB THERAPY OF NORTHERN COLORADO LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2928 W 10TH ST STE 101 | ||||||||
Address2: |   | ||||||||
City: | GREELEY | ||||||||
State: | CO | ||||||||
PostalCode: | 806345434 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3038295997 | ||||||||
FaxNumber: | 9703512427 | ||||||||
Practice Location | |||||||||
Address1: | 2928 W 10TH ST STE 101 | ||||||||
Address2: |   | ||||||||
City: | GREELEY | ||||||||
State: | CO | ||||||||
PostalCode: | 806345434 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3038295997 | ||||||||
FaxNumber: | 9703512427 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/23/2021 | ||||||||
LastUpdateDate: | 04/23/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CAMPBELL | ||||||||
AuthorizedOfficialFirstName: | TARA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9703512412 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | ACCELERATED REHAB THERAPY OF NORTHERN COLORADO LLC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081N0008X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine | 2081P2900X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 261QM1300X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.