Active NPI
Reform Health & Rehab, LLC
- Physical Therapist
- Boulder, CO
National Provider Identifier
1013551852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- REFORM HEALTH & REHAB, LLC
- Practice address
- 2750 Broadway St
Boulder, CO 80304-3573 - Phone
- (303) 440-3034
- Fax
- (303) 402-1665
- NPI assigned
- Nov 5, 2019
- Organization subpart
- Yes
- Parent organization
- REFORM HEALTH & REHAB, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Blaine Stimac, MSPT
- Title
- Ceo, Managing Member
- Phone
- (406) 756-1128
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
2750 Broadway St
Boulder, CO 80304-3573
Mailing address
PO Box 5718
Kalispell, MT 59903-5718
Phone (406) 756-0134
Other names 1
- North Boulder Physical Therapy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200106000507 | CO | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 6002240744 |
Receives reassigned benefits from 14 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Golden, CO; Westminster, CO; Boulder, CO |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Reform Health Rehab LLC
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Physical Therapist
- Boulder, CO
- NPI 1295384667
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572912000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1689724800000",
"number": "1013551852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5718",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599035718",
"telephone_number": "406-756-0134",
"fax_number": "406-309-2579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2750 BROADWAY ST",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043573",
"telephone_number": "303-440-3034",
"fax_number": "303-402-1665"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REFORM HEALTH & REHAB, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "REFORM HEALTH & REHAB, LLC",
"enumeration_date": "2019-11-05",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"status": "A",
"authorized_official_last_name": "STIMAC",
"authorized_official_first_name": "BLAINE",
"authorized_official_title_or_position": "CEO, MANAGING MEMBER",
"authorized_official_telephone_number": "406-756-1128",
"authorized_official_credential": "MSPT"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "North Boulder Physical Therapy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "North Boulder Physical Therapy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.