Provider Demographics
NPI:1497261523
Name:BREAKTHROUGH REGENERATIVE ORTHOPEDICS
Entity Type:Organization
Organization Name:BREAKTHROUGH REGENERATIVE ORTHOPEDICS
Other - Org Name:REGENERATIVE ORTHOPEDICS & SPORTS MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-463-0567
Mailing Address - Street 1:5420 ARAPAHOE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1250
Mailing Address - Country:US
Mailing Address - Phone:720-463-0567
Mailing Address - Fax:303-494-5371
Practice Address - Street 1:5420 ARAPAHOE AVE STE A
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1250
Practice Address - Country:US
Practice Address - Phone:720-463-0567
Practice Address - Fax:303-494-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00041636207XX0005X
207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty