NPIMap

Organization Active NPI

Reform Health & Rehab, LLC

Doing business as North Boulder Physical Therapy

  • Physical Therapist
  • Boulder, CO
National Provider Identifier
1295384667
Registry record updated Jul 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
REFORM HEALTH & REHAB, LLC
Doing business as
North Boulder Physical Therapy
Practice address
3000 Center Green Dr Ste 110
Boulder, CO 80301-2364
Phone
(303) 413-9903
Fax
(303) 413-9907
NPI assigned
Sep 9, 2019
Last updated
Jul 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2023

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

Authorized official

Name
Blaine Stimac, MSPTNPI 1649277567
Title
Ceo, Managing Member
Phone
(406) 756-1128

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

3000 Center Green Dr Ste 110
Boulder, CO 80301-2364

Mailing address

PO Box 5718
Kalispell, MT 59903-5718
Phone (406) 756-0134

Other names 1

  • North Boulder Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
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

Locations

9250 E Costilla Ave
Ste 201
Greenwood Village, CO 80112
Phone (720) 572-4873

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1567987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689724800000",
    "number": "1295384667",
    "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": "406-300-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 CENTER GREEN DR STE 110",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012364",
            "telephone_number": "303-413-9903",
            "fax_number": "303-413-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REFORM HEALTH & REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-09",
        "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": "193400000X SINGLE 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"
        }
    ]
}

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.

Verify at the official NPI Registry.