Healthcare Provider Details

I. General information

NPI: 1851348239
Provider Name (Legal Business Name): FORT COLLINS PHYSICAL THERAPY AND SPORTS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E PROSPECT RD
FORT COLLINS CO
80525-1115
US

IV. Provider business mailing address

1325 E PROSPECT RD
FORT COLLINS CO
80525-1115
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-0173
  • Fax: 970-221-0177
Mailing address:
  • Phone: 970-221-0173
  • Fax: 970-221-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1910
License Number StateCO

VIII. Authorized Official

Name: TRAVIS JAMES EDWARDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 970-221-0173