Provider Demographics
NPI:1275857518
Name:FLORES, LUIS ROQUE (PT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ROQUE
Last Name:FLORES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 S NARCISSUS WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2025
Mailing Address - Country:US
Mailing Address - Phone:303-884-4599
Mailing Address - Fax:
Practice Address - Street 1:1655 YARROW ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-6030
Practice Address - Country:US
Practice Address - Phone:303-232-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066650Medicare PIN