MEDICARE: ADVANCED SPINE & REHABILITATION

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	:	1992790141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SPINE & REHABILITATION

Provider Business Mailing Address
First Line	:	343 W DRAKE RD
Second Line	:	STE 102
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6317
Country	:	US
Telephone Number	:	970-204-9635
Fax Number	:	970-204-9730

Provider Business Practice Location Address
First Line	:	343 W DRAKE RD
Second Line	:	STE 102
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6317
Country	:	US
Telephone Number	:	970-204-9635
Fax Number	:	970-204-9730

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. GRANT BARCLAY
Credential	:
Telephone Number	:	970-204-9635

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	08/22/2020

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