Provider Demographics
NPI:1598801391
Name:COLORADO ORTHOPEDIC REHABILITATION SPECIALIST, LLC
Entity Type:Organization
Organization Name:COLORADO ORTHOPEDIC REHABILITATION SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:SCHOONVELD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, MTC
Authorized Official - Phone:303-457-2022
Mailing Address - Street 1:11325 N. COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233
Mailing Address - Country:US
Mailing Address - Phone:303-457-2022
Mailing Address - Fax:303-457-2320
Practice Address - Street 1:11325 N. COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233
Practice Address - Country:US
Practice Address - Phone:303-457-2022
Practice Address - Fax:303-457-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6712261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28606264Medicaid
CO7238042OtherCIGNA
CO605038800OtherOWCP
COSCSC6685OtherANTHEM BLUE CROSS
CO28606264Medicaid