Provider Demographics
NPI:1942848734
Name:COLORADO PHYSICAL THERAPY SPECIALISTS PLLC
Entity Type:Organization
Organization Name:COLORADO PHYSICAL THERAPY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF HR AND FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:970-221-1201
Mailing Address - Street 1:210 W MAGNOLIA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2915
Mailing Address - Country:US
Mailing Address - Phone:970-221-1201
Mailing Address - Fax:
Practice Address - Street 1:2021 BATTLECREEK DR UNIT A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-5120
Practice Address - Country:US
Practice Address - Phone:970-221-1201
Practice Address - Fax:800-675-0273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO PHYSICAL THERAPY SPECIALISTS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-12
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000171043Medicaid