Provider Demographics
NPI:1164820916
Name:OSTEOPATHIC PAIN AND REHABILITATION MEDICINE, A PROFESSIONAL LLC.
Entity Type:Organization
Organization Name:OSTEOPATHIC PAIN AND REHABILITATION MEDICINE, A PROFESSIONAL LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:720-695-7288
Mailing Address - Street 1:3000 CENTER GREEN DR
Mailing Address - Street 2:#130
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2364
Mailing Address - Country:US
Mailing Address - Phone:720-695-7288
Mailing Address - Fax:888-388-8602
Practice Address - Street 1:3000 CENTER GREEN DR
Practice Address - Street 2:#130
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2364
Practice Address - Country:US
Practice Address - Phone:720-695-7288
Practice Address - Fax:888-388-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0052372208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty