Provider Demographics
NPI:1437862406
Name:THE PHYSIOROOM, LLC
Entity Type:Organization
Organization Name:THE PHYSIOROOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROBL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:720-560-5326
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:720-316-9974
Mailing Address - Fax:720-294-0332
Practice Address - Street 1:5058 S SYRACUSE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2702
Practice Address - Country:US
Practice Address - Phone:720-316-9974
Practice Address - Fax:720-294-0332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PHYSIOROOM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty