Provider Demographics
NPI:1013186592
Name:FRONTIER MOBILE THERAPY PLLC
Entity Type:Organization
Organization Name:FRONTIER MOBILE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-770-1305
Mailing Address - Street 1:7180 E ORCHARD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1725
Mailing Address - Country:US
Mailing Address - Phone:303-770-1305
Mailing Address - Fax:
Practice Address - Street 1:7180 E ORCHARD RD STE 110
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1725
Practice Address - Country:US
Practice Address - Phone:303-770-1305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7875261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy