Provider Demographics
NPI:1922207133
Name:REDROCK PHYSICAL MEDICINE & REHABILIATION PC
Entity Type:Organization
Organization Name:REDROCK PHYSICAL MEDICINE & REHABILIATION PC
Other - Org Name:ELLEN PRICE DO PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-858-2565
Mailing Address - Street 1:551 KOKOPELLI BLVD UNIT J
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-6305
Mailing Address - Country:US
Mailing Address - Phone:970-858-2585
Mailing Address - Fax:970-858-2555
Practice Address - Street 1:551 KOKOPELLI BLVD UNIT J
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-6305
Practice Address - Country:US
Practice Address - Phone:970-858-2585
Practice Address - Fax:970-858-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30888225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C284908OtherMEDICARE ID