Healthcare Provider Details

I. General information

NPI: 1659821643
Provider Name (Legal Business Name): FUNCTIONAL REHAB AND MOVEMENT SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3996 RED CEDAR DR SUITE 6-A
HIGHLANDS RANCH CO
80126-8065
US

IV. Provider business mailing address

3996 RED CEDAR DR SUITE 6-A
HIGHLANDS RANCH CO
80126-8065
US

V. Phone/Fax

Practice location:
  • Phone: 720-408-0321
  • Fax: 720-408-0320
Mailing address:
  • Phone: 720-408-0321
  • Fax: 720-408-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10999
License Number StateCO

VIII. Authorized Official

Name: WILLIAM GREGOIRE
Title or Position: PHYSICAL THERAPIST / OWNER
Credential: PT, DPT
Phone: 720-408-0321