Provider Demographics
NPI:1114171808
Name:BACH, ROBIN A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:BACH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14661 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9422
Mailing Address - Country:US
Mailing Address - Phone:720-288-1935
Mailing Address - Fax:
Practice Address - Street 1:14661 CLAY ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9422
Practice Address - Country:US
Practice Address - Phone:720-288-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5833OtherSTATE PHYSICAL THERAPY LICENSE NUMBER