Provider Demographics
NPI:1043210693
Name:FORT COLLINS THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:FORT COLLINS THERAPY SERVICES LLC
Other - Org Name:ABG THERAPY & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC/SLP
Authorized Official - Phone:970-663-3222
Mailing Address - Street 1:3780 N GARFIELD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2237
Mailing Address - Country:US
Mailing Address - Phone:970-663-3222
Mailing Address - Fax:970-663-3227
Practice Address - Street 1:3780 N GARFIELD AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2237
Practice Address - Country:US
Practice Address - Phone:970-663-3222
Practice Address - Fax:970-663-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53828321Medicaid