Provider Demographics
NPI:1619531852
Name:FUNCTIONAL PERFORMANCE MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:FUNCTIONAL PERFORMANCE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:970-215-0565
Mailing Address - Street 1:18293 E EUCLID PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1143
Mailing Address - Country:US
Mailing Address - Phone:970-215-0565
Mailing Address - Fax:
Practice Address - Street 1:6169 S BALSAM WAY STE 110
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3000
Practice Address - Country:US
Practice Address - Phone:303-948-1868
Practice Address - Fax:303-948-1741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUNCTIONAL PERFORMANCE PHYSICAL THERAPY CENTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies