1538614532 NPI number — FORTITUDE PHYSICAL THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538614532 NPI number — FORTITUDE PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORTITUDE PHYSICAL THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FORTITUDE PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538614532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9208 GRAND CORDERA PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80924-7022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-522-2000
Provider Business Mailing Address Fax Number:
719-522-2050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 FORESIGHT CIR E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81505-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-685-8951
Provider Business Practice Location Address Fax Number:
719-685-8958
Provider Enumeration Date:
08/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ESMAS
Authorized Official First Name:
BARTOLOME
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT ADMINISTRATOR
Authorized Official Telephone Number:
720-214-7777

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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