Provider Demographics
NPI:1861149718
Name:MELROSE AND MELROSE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MELROSE AND MELROSE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MELROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:209-292-3902
Mailing Address - Street 1:4610 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4715
Mailing Address - Country:US
Mailing Address - Phone:209-292-3902
Mailing Address - Fax:
Practice Address - Street 1:4610 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-4715
Practice Address - Country:US
Practice Address - Phone:209-292-3902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy