1073546446 NPI number — NORTHMETRO PHYSICAL THERAPY AND WELLNESS PC

Table of content: (NPI 1073546446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073546446 NPI number — NORTHMETRO PHYSICAL THERAPY AND WELLNESS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHMETRO PHYSICAL THERAPY AND WELLNESS PC
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:
Provider Other Organization Name Type Code:
6
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:
1073546446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 E 130TH AVE
Provider Second Line Business Mailing Address:
UNIT B
Provider Business Mailing Address City Name:
THORNTON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80241-3933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-982-3783
Provider Business Mailing Address Fax Number:
303-452-3087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 LIMON DR
Provider Second Line Business Practice Location Address:
SUITE 258
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80525-7643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-213-9579
Provider Business Practice Location Address Fax Number:
970-282-1892
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILANI
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
720-982-3783

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  7772 , 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)





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