Provider Demographics
NPI:1043992498
Name:MILE HIGH SPORTS AND REHABILITATION MEDICINE, PC
Entity Type:Organization
Organization Name:MILE HIGH SPORTS AND REHABILITATION MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-331-6744
Mailing Address - Street 1:2490 W 26TH AVE STE 10A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5300
Mailing Address - Country:US
Mailing Address - Phone:303-331-6744
Mailing Address - Fax:303-331-6839
Practice Address - Street 1:4545 E 9TH AVE STE 440
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3914
Practice Address - Country:US
Practice Address - Phone:303-331-6744
Practice Address - Fax:303-331-6839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty