Provider Demographics
NPI: | 1962148817 |
---|---|
Name: | COLORADO IN MOTION LLC |
Entity type: | Organization |
Organization Name: | COLORADO IN MOTION LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TERRY |
Authorized Official - Middle Name: | LEE |
Authorized Official - Last Name: | GEBHARDT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 970-221-1201 |
Mailing Address - Street 1: | 175 S ENGLISH STATION RD STE 218 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40245-4199 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 812-759-7451 |
Mailing Address - Fax: | 812-759-7482 |
Practice Address - Street 1: | 331 HICKORY ST STE 130 |
Practice Address - Street 2: | |
Practice Address - City: | FORT COLLINS |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80524-1138 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-221-1201 |
Practice Address - Fax: | 800-675-0273 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-05-12 |
Last Update Date: | 2022-05-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |