MEDICARE: FUNCTIONAL REHAB AND MOVEMENT SPECIALISTS LLC

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	10999	CO

General Provider Information

NPI Number	:	1659821643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL REHAB AND MOVEMENT SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	3996 RED CEDAR DR
Second Line	:	SUITE 6-A
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-8065
Country	:	US
Telephone Number	:	720-408-0321
Fax Number	:	720-408-0320

Provider Business Practice Location Address
First Line	:	3996 RED CEDAR DR
Second Line	:	SUITE 6-A
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-8065
Country	:	US
Telephone Number	:	720-408-0321
Fax Number	:	720-408-0320

Authorized Official
Title or Position	:	PHYSICAL THERAPIST / OWNER
Name	:	WILLIAM GREGOIRE
Credential	:	PT, DPT
Telephone Number	:	720-408-0321

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/06/2017

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