NPIMap

Organization Active NPI

Fort Collins Medi-Spa

  • Mechanotherapist
  • Fort Collins, CO
National Provider Identifier
1134450539
Registry record updated Jan 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
MechanotherapistTaxonomy code 172M00000X
Legal business name
FORT COLLINS MEDI-SPA
Practice address
4103 Boardwalk Dr
Suite 100
Fort Collins, CO 80525-5931
Phone
(970) 204-0400
Fax
(970) 377-1082
NPI assigned
Jan 25, 2010
Last updated
Jan 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2010

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

Authorized official

Name
Dr. Kevin J Anderson, OD
Title
Ceo
Phone
(970) 204-0400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Reflexologist 173C00000X NU
Mechanotherapist 172M00000X NU Primary

Addresses

Primary practice location

4103 Boardwalk Dr
Suite 100
Fort Collins, CO 80525-5931

Mailing address

4103 Boardwalk Dr
Suite 100
Fort Collins, CO 80525-5931
Phone (970) 204-0400

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1264377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264377600000",
    "number": "1134450539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 BOARDWALK DR",
            "address_2": "SUITE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255931",
            "telephone_number": "970-204-0400",
            "fax_number": "970-377-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 BOARDWALK DR",
            "address_2": "SUITE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255931",
            "telephone_number": "970-204-0400",
            "fax_number": "970-377-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT COLLINS MEDI-SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-25",
        "last_updated": "2010-01-25",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-204-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "173C00000X",
            "taxonomy_group": "",
            "desc": "Reflexologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 25, 2010; 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.