Provider Demographics
NPI:1659852051
Name:CHOICE CITY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CHOICE CITY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TYSON
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:970-460-8544
Mailing Address - Street 1:2100 W DRAKE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1400
Mailing Address - Country:US
Mailing Address - Phone:970-460-8544
Mailing Address - Fax:
Practice Address - Street 1:2100 W DRAKE RD STE 3
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1400
Practice Address - Country:US
Practice Address - Phone:970-460-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18780385Medicaid