Provider Demographics
NPI:1083712178
Name:BALANCED ROCK SPORTS AND ORTHOPAEDICS
Entity Type:Organization
Organization Name:BALANCED ROCK SPORTS AND ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-523-5003
Mailing Address - Street 1:590 32 RD
Mailing Address - Street 2:6F
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 32 RD
Practice Address - Street 2:6F
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7621
Practice Address - Country:US
Practice Address - Phone:970-523-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSP27819OtherBLUE CROSS
COSP27819OtherBLUE CROSS