Healthcare Provider Details

I. General information

NPI: 1639155708
Provider Name (Legal Business Name): INSTITUTE OF PHYSICAL MEDICINE & SPORTS THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MAIN ST UNIT 8
WINDSOR CO
80550-4753
US

IV. Provider business mailing address

1180 MAIN ST UNIT 8
WINDSOR CO
80550-4753
US

V. Phone/Fax

Practice location:
  • Phone: 970-674-8011
  • Fax: 970-674-8051
Mailing address:
  • Phone: 970-674-8011
  • Fax: 970-674-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6452
License Number StateCO

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. SCOTT ALAN JOHNSON
Title or Position: OWNER
Credential: PT
Phone: 970-674-8011