NPIMap

Organization Active NPI

Performance Physical Therapy & Rehabilitation , PC

  • Physical Therapist
  • Fort Collins, CO
National Provider Identifier
1144336835
Registry record updated Oct 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PERFORMANCE PHYSICAL THERAPY & REHABILITATION , PC
Practice address
3519 Richmond Drive #C
Fort Collins, CO 80526-5994
Phone
(970) 493-8727
Fax
(970) 493-8739
NPI assigned
Aug 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2007

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

Authorized official

Name
Paula M Nickel, MSPTNPI 1679689376
Title
Owner, PT
Phone
(970) 493-8727

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 CO Primary

Addresses

Primary practice location

3519 Richmond Drive #C
Fort Collins, CO 80526-5994

Mailing address

3519 Richmond Drive #C
Fort Collins, CO 80526-5994
Phone (970) 493-8727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040302001376 CO Part B Supplier - Clinic/Group Practice 3173410206 Receives reassigned benefits from 4 practitioners
Practice locations: Fort Collins, CO

National Provider Directory

National Provider Directory

Locations

3519 Richmond Dr
Ste C
Fort Collins, CO 80526
Phone (970) 377-2020

2001 S Shields St
Ste H102
Fort Collins, CO 80526
Phone (970) 493-8727

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1144336835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3519 RICHMOND DRIVE #C",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805265994",
            "telephone_number": "970-493-8727",
            "fax_number": "970-493-8739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3519 RICHMOND DRIVE #C",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805265994",
            "telephone_number": "970-493-8727",
            "fax_number": "970-493-8739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PHYSICAL THERAPY & REHABILITATION , PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "NICKEL",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER, PT",
        "authorized_official_telephone_number": "970-493-8727",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CO",
            "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 Oct 15, 2007; 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.

Verify at the official NPI Registry.