1790013001 NPI number — ROCKY MOUNTAIN PHYSICAL THERAPY, INC

Table of content: (NPI 1790013001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790013001 NPI number — ROCKY MOUNTAIN PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY MOUNTAIN PHYSICAL THERAPY, INC
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:
ROCKY MOUNTAIN 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:
1790013001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2121 E HARMONY RD UNIT 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80528-3403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-689-3236
Provider Business Mailing Address Fax Number:
970-460-0136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1159 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80550-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-460-0066
Provider Business Practice Location Address Fax Number:
970-460-0136
Provider Enumeration Date:
11/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTOFF
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-223-2061

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9941 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: COB4918 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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