Provider Demographics
NPI:1245549849
Name:ROCKY MOUNTAIN SPINE & SPORT
Entity type:Organization
Organization Name:ROCKY MOUNTAIN SPINE & SPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-792-7377
Mailing Address - Street 1:475 W 12TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3685
Mailing Address - Country:US
Mailing Address - Phone:303-455-0366
Mailing Address - Fax:303-756-1337
Practice Address - Street 1:475 W 12TH AVE
Practice Address - Street 2:STE A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3685
Practice Address - Country:US
Practice Address - Phone:303-455-0366
Practice Address - Fax:303-756-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC477678Medicare PIN