Provider Demographics
NPI:1689600256
Name:COLORADO PAIN & REHABILITATION PLLC
Entity Type:Organization
Organization Name:COLORADO PAIN & REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-423-8334
Mailing Address - Street 1:125 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2546
Mailing Address - Country:US
Mailing Address - Phone:303-788-9322
Mailing Address - Fax:303-788-9337
Practice Address - Street 1:125 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2546
Practice Address - Country:US
Practice Address - Phone:303-788-9322
Practice Address - Fax:303-788-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18859020Medicaid