Provider Demographics
NPI:1598403560
Name:ROTHWELL, JERIMIE MICHAEL WILLIAM
Entity Type:Individual
Prefix:
First Name:JERIMIE
Middle Name:MICHAEL WILLIAM
Last Name:ROTHWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 S EMPORIA WAY UNIT I-204
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-8212
Mailing Address - Country:US
Mailing Address - Phone:850-375-1520
Mailing Address - Fax:
Practice Address - Street 1:2550 S PARKER RD STE 150
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1655
Practice Address - Country:US
Practice Address - Phone:720-512-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist