Provider Demographics
NPI:1477188274
Name:PHYSICAL MEDICINE OF THE ROCKIES LLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE OF THE ROCKIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRIMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-457-6001
Mailing Address - Street 1:9025 GRANT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4347
Mailing Address - Country:US
Mailing Address - Phone:719-465-0069
Mailing Address - Fax:720-930-4252
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3925
Practice Address - Country:US
Practice Address - Phone:719-465-0069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty