MEDICARE: FRONT RANGE THERAPY SYSTEMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11284	CO

General Provider Information

NPI Number	:	1457759169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT RANGE THERAPY SYSTEMS

Provider Business Mailing Address
First Line	:	802 W DRAKE RD STE 145
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 W DRAKE RD STE 133
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-5567
Country	:	US
Telephone Number	:	970-494-6449
Fax Number	:

Authorized Official
Title or Position	:	PT/DIRECTOR OF THERAPY
Name	:	RARA GILBERT
Credential	:	PT
Telephone Number	:	970-290-2075

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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