Provider Demographics
NPI:1831452812
Name:MICHELE FORSBERG PT, PC
Entity type:Organization
Organization Name:MICHELE FORSBERG PT, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:720-204-6546
Mailing Address - Street 1:3536 FOXTAIL PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7571
Mailing Address - Country:US
Mailing Address - Phone:720-204-6546
Mailing Address - Fax:
Practice Address - Street 1:2919 17TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-1657
Practice Address - Country:US
Practice Address - Phone:720-204-6546
Practice Address - Fax:720-405-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-24
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty