Provider Demographics
NPI:1851463103
Name:NECK & BACK REHABILITATION
Entity Type:Organization
Organization Name:NECK & BACK REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-688-8822
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-0965
Mailing Address - Country:US
Mailing Address - Phone:303-688-8822
Mailing Address - Fax:303-688-8830
Practice Address - Street 1:901 PARK ST # B
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-1527
Practice Address - Country:US
Practice Address - Phone:303-688-8822
Practice Address - Fax:303-688-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty