NPIMap

Organization Active NPI

Foothills Orthopedic & Sport Therapy, PC

  • Physical Therapist
  • Fort Collins, CO
National Provider Identifier
1013671429
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FOOTHILLS ORTHOPEDIC & SPORT THERAPY, PC
Practice address
3938 JFK Pkwy Unit 11E
Fort Collins, CO 80525-3087
Phone
(970) 207-1500
Fax
(970) 207-0075
NPI assigned
Oct 22, 2021
Organization subpart
Yes
Parent organization
FOOTHILLS ORTHOPEDIC & SPORT THERAPY P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Duane Allen Pedersen, MSPTNPI 1720321672
Title
Practice Manager
Phone
(970) 667-7755

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3938 JFK Pkwy Unit 11E
Fort Collins, CO 80525-3087

Mailing address

2964 Ginnala Dr
Loveland, CO 80538-2701
Phone (970) 667-7755

Other identifiers 1

IdentifierTypeStateIssuer
02103354MedicaidCO

National Provider Directory

National Provider Directory
Part of
Foothills Orthopedic Sport

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1013671429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2964 GINNALA DR",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805382701",
            "telephone_number": "970-667-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3938 JFK PKWY UNIT 11E",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253087",
            "telephone_number": "970-207-1500",
            "fax_number": "970-207-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS ORTHOPEDIC & SPORT THERAPY, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOOTHILLS ORTHOPEDIC & SPORT THERAPY P.C.",
        "enumeration_date": "2021-10-22",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "970-667-7755",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02103354",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.