Provider Demographics
NPI:1629168505
Name:ROCKY MOUNTAIN SPINE AND SPORT, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN SPINE AND SPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-792-7377
Mailing Address - Street 1:9218 KIMMER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6732
Mailing Address - Country:US
Mailing Address - Phone:303-792-7377
Mailing Address - Fax:303-792-9077
Practice Address - Street 1:9218 KIMMER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6732
Practice Address - Country:US
Practice Address - Phone:303-792-7377
Practice Address - Fax:303-792-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO662341OtherBLUE CROSS BLUE SHIELD
CO662341OtherBLUE CROSS BLUE SHIELD