NPIMap

Organization Active NPI

Physiom Associates, PLLC

  • Physical Medicine & Rehabilitation Physician
  • Fort Collins, CO
National Provider Identifier
1124100763
Registry record updated Jun 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
PHYSIOM ASSOCIATES, PLLC
Practice address
1300 Oakridge Dr
#130
Fort Collins, CO 80525-5564
Phone
(970) 377-9555
Fax
(970) 377-9559
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2011

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

Authorized official

Name
Bruce A Lockwood, MD
Title
Officer
Phone
(970) 377-9555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

1300 Oakridge Dr
#130
Fort Collins, CO 80525-5564

Mailing address

1300 Oakridge Dr
#130
Fort Collins, CO 80525-5564
Phone (970) 377-9555

Other identifiers 2

IdentifierTypeStateIssuer
40137724MedicaidCO
445119MedicaidAZ

National Provider Directory

National Provider Directory

Locations

Denver, CO 80291

1300 Oakridge Dr
Ste 130
Fort Collins, CO 80525
Phone (877) 377-9555

Practitioners & affiliated clinicians

Practitioners 6

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308787200000",
    "number": "1124100763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 OAKRIDGE DR",
            "address_2": "#130",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255564",
            "telephone_number": "970-377-9555",
            "fax_number": "970-377-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 OAKRIDGE DR",
            "address_2": "#130",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255564",
            "telephone_number": "970-377-9555",
            "fax_number": "970-377-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIOM ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2011-06-23",
        "status": "A",
        "authorized_official_last_name": "LOCKWOOD",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "970-377-9555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40137724",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "445119",
            "state": "AZ"
        }
    ],
    "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 Jun 23, 2011; 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.