Healthcare Provider Details

I. General information

NPI: 1770892085
Provider Name (Legal Business Name): PHYSICAL MEDICINE CENTER OF THE ROCKIES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 E HARMONY RD STE 110
FORT COLLINS CO
80528-3412
US

IV. Provider business mailing address

2244 E HARMONY RD STE 110
FORT COLLINS CO
80528-3412
US

V. Phone/Fax

Practice location:
  • Phone: 970-226-1117
  • Fax: 970-226-0251
Mailing address:
  • Phone: 970-226-1117
  • Fax: 970-226-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHR-5953
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHR-5887
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number49380
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number990425
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP990032
License Number StateCO

VIII. Authorized Official

Name: DR. MICHAEL WAYNE FARRELL
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 970-226-1117