Healthcare Provider Details

I. General information

NPI: 1386702298
Provider Name (Legal Business Name): COLORADO PHYSICAL THERAPY SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W MAGNOLIA ST SUITE 110
FORT COLLINS CO
80521-2915
US

IV. Provider business mailing address

210 W MAGNOLIA ST SUITE 110
FORT COLLINS CO
80521-2915
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1201
  • Fax: 800-675-0273
Mailing address:
  • Phone: 970-221-1201
  • Fax: 800-675-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY LEE GEBHARDT
Title or Position: MEMBER
Credential: PT
Phone: 970-221-1201