Provider Demographics
NPI:1073535118
Name:FRONT RANGE THERAPY SYSTEMS, INC.
Entity Type:Organization
Organization Name:FRONT RANGE THERAPY SYSTEMS, INC.
Other - Org Name:MARKET CENTRE REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-482-0198
Mailing Address - Street 1:802 W DRAKE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5567
Mailing Address - Country:US
Mailing Address - Phone:970-492-6238
Mailing Address - Fax:970-492-6206
Practice Address - Street 1:802 W DRAKE RD
Practice Address - Street 2:SUITE 133
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5567
Practice Address - Country:US
Practice Address - Phone:970-492-6238
Practice Address - Fax:970-492-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO064517Medicare ID - Type UnspecifiedMEDICARE PROVIDER #