Provider Demographics
NPI:1679819569
Name:COLLABORATIVE REHAB LLC
Entity Type:Organization
Organization Name:COLLABORATIVE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSMUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-621-4605
Mailing Address - Street 1:4001 HOME ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-2802
Mailing Address - Country:US
Mailing Address - Phone:720-445-7833
Mailing Address - Fax:
Practice Address - Street 1:350 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-7605
Practice Address - Country:US
Practice Address - Phone:720-445-7833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLTERRA HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty