Provider Demographics
NPI:1497773113
Name:FRONT RANGE THERAPIES PARKER PC
Entity Type:Organization
Organization Name:FRONT RANGE THERAPIES PARKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTEFERRANTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-841-5594
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:
Practice Address - Street 1:19641 E PARKER SQUARE DR
Practice Address - Street 2:SUITE I
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7399
Practice Address - Country:US
Practice Address - Phone:303-841-5594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COFRT27515OtherBLUE SHIELD
COC804859Medicare PIN