Healthcare Provider Details

I. General information

NPI: 1235760190
Provider Name (Legal Business Name): PHYSIOFIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 ROBERTSON ST
FORT COLLINS CO
80524-3926
US

IV. Provider business mailing address

5602 SCARLET IBIS LN
FORT COLLINS CO
80525-7147
US

V. Phone/Fax

Practice location:
  • Phone: 970-281-5241
  • Fax:
Mailing address:
  • Phone: 563-260-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ELIZABETH A DESSNER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 563-260-1156