Provider Demographics
NPI:1407834377
Name:FAMILY PHYSICAL THERAPY CENTER, P.C.
Entity Type:Organization
Organization Name:FAMILY PHYSICAL THERAPY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIVOIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-266-3850
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8615
Mailing Address - Country:US
Mailing Address - Phone:970-266-3850
Mailing Address - Fax:970-266-3855
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8614
Practice Address - Country:US
Practice Address - Phone:970-266-3850
Practice Address - Fax:970-266-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-02
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07044035Medicaid
CO07044035Medicaid