MEDICARE: MR. MICHAEL JOHN RESSLER MPT

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	2251E1200X	Ergonomics Physical Therapist	CO6892	CO
2	2251S0007X	Sports Physical Therapist	CO6892	CO
3	2251X0800X	Orthopedic Physical Therapist	CO6892	CO
4	225100000X	Physical Therapist	CO6892	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	662283	OTHER	CO	BC/BS PROVIDER ID

General Provider Information

NPI Number	:	1730108598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOHN RESSLER MPT

Provider Business Mailing Address
First Line	:	1939 WILMINGTON DR
Second Line	:	SUITE 101
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-6299
Country	:	US
Telephone Number	:	970-377-1422
Fax Number	:	970-377-1839

Provider Business Practice Location Address
First Line	:	1939 WILMINGTON DR
Second Line	:	SUITE 101
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-6299
Country	:	US
Telephone Number	:	970-377-1422
Fax Number	:	970-377-1839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/16/2022

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Directions to “ MR. MICHAEL JOHN RESSLER MPT” Practice Location

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