Provider Demographics
NPI:1184846966
Name:ROCKY MOUNTAIN REHABILITATION SPECIALIST LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN REHABILITATION SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BASSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-777-3422
Mailing Address - Street 1:1380 S SANTA FE DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-3260
Mailing Address - Country:US
Mailing Address - Phone:303-777-3422
Mailing Address - Fax:303-777-3425
Practice Address - Street 1:1380 S SANTA FE DR
Practice Address - Street 2:STE. 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-3260
Practice Address - Country:US
Practice Address - Phone:303-777-3422
Practice Address - Fax:303-777-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO295482081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF24926Medicare UPIN