Provider Demographics
NPI:1700405099
Name:FRONT RANGE PEDIATRIC THERAPIES LLC
Entity Type:Organization
Organization Name:FRONT RANGE PEDIATRIC THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:888-701-9216
Mailing Address - Street 1:5265 N ACADEMY BLVD STE 3300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4082
Mailing Address - Country:US
Mailing Address - Phone:888-701-9216
Mailing Address - Fax:866-569-1087
Practice Address - Street 1:5265 N ACADEMY BLVD STE 3300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4082
Practice Address - Country:US
Practice Address - Phone:888-701-9216
Practice Address - Fax:866-569-1087
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONT RANGE PEDIATRIC THERAPIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-16
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health