Provider Demographics
NPI:1710059936
Name:GILMORENO DE MORA, RODRIGO (DPT)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:GILMORENO DE MORA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 TAURUS CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3280
Mailing Address - Country:US
Mailing Address - Phone:970-593-1442
Mailing Address - Fax:970-667-1740
Practice Address - Street 1:1542 TAURUS CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3280
Practice Address - Country:US
Practice Address - Phone:970-593-1442
Practice Address - Fax:970-667-1740
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO134209263225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic