Provider Demographics
NPI:1083975635
Name:ROBERTS, CODIE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:CODIE
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CODIE
Other - Middle Name:MARIE
Other - Last Name:BYINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11169 E I25 FRONTAGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5211
Mailing Address - Country:US
Mailing Address - Phone:720-600-0370
Mailing Address - Fax:
Practice Address - Street 1:9800 MT PYRAMID CT STE 400
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-2669
Practice Address - Country:US
Practice Address - Phone:720-600-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172059Medicare PIN
IAI19172Medicare PIN