Provider Demographics
NPI:1386300341
Name:RESILIENT PHYSIOTHERAPY AND PERFORMANCE, LLC
Entity type:Organization
Organization Name:RESILIENT PHYSIOTHERAPY AND PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT, OCS, FAAOMPT
Authorized Official - Phone:970-526-6038
Mailing Address - Street 1:1402 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4650
Mailing Address - Country:US
Mailing Address - Phone:970-526-6038
Mailing Address - Fax:970-526-6054
Practice Address - Street 1:1402 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4650
Practice Address - Country:US
Practice Address - Phone:970-526-6038
Practice Address - Fax:970-526-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy