Basic Information
| Provider Information | |||||||||
| NPI: | 1457759169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRONT RANGE THERAPY SYSTEMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 W DRAKE RD STE 145 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265567 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 802 W DRAKE RD STE 133 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704946449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2014 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | RARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PT/DIRECTOR OF THERAPY | ||||||||
| AuthorizedOfficialTelephone: | 9702902075 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11284 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.