Provider Demographics
NPI:1134793730
Name:FOUNDATIONS PHYSICAL THERAPY
Entity type:Organization
Organization Name:FOUNDATIONS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEST
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, WCS
Authorized Official - Phone:928-350-8270
Mailing Address - Street 1:756 W CATTLE DRIVE TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-6970
Mailing Address - Country:US
Mailing Address - Phone:289-925-8146
Mailing Address - Fax:
Practice Address - Street 1:403 W BIRCH AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4467
Practice Address - Country:US
Practice Address - Phone:928-925-8146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy