MEDICARE: FRONT RANGE PHYSICAL THERAPY SERVICES 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1902682339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT RANGE PHYSICAL THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	1075 E SOUTH BOULDER RD STE 140
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2559
Country	:	US
Telephone Number	:	720-534-0781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 E SOUTH BOULDER RD STE 140
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2559
Country	:	US
Telephone Number	:	720-534-0781
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARC PHILLIPS
Credential	:	PT, DPT, OCS
Telephone Number	:	719-232-8079

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	01/04/2024

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