Provider Demographics
NPI:1720151616
Name:CENTER FOR ORTHOPEDIC REHABILITATION & EXERCISE LLC
Entity type:Organization
Organization Name:CENTER FOR ORTHOPEDIC REHABILITATION & EXERCISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:970-223-8293
Mailing Address - Street 1:UNIT A
Mailing Address - Street 2:140 EAST BOARDWALK DRIVE
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3153
Mailing Address - Country:US
Mailing Address - Phone:970-223-8293
Mailing Address - Fax:970-223-8219
Practice Address - Street 1:UNIT A
Practice Address - Street 2:140 EAST BOARDWALK DRIVE
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3153
Practice Address - Country:US
Practice Address - Phone:970-223-8293
Practice Address - Fax:970-223-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC552938Medicare PIN