Provider Demographics
NPI:1336383199
Name:COLORADO SPINE & ORTHOPEDIC REHABILITATION CENTER, P.C.
Entity Type:Organization
Organization Name:COLORADO SPINE & ORTHOPEDIC REHABILITATION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-367-2225
Mailing Address - Street 1:8250 PARK MEADOWS DRIVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-951-7525
Mailing Address - Fax:303-768-8450
Practice Address - Street 1:8250 PARK MEADOWS DRIVE
Practice Address - Street 2:SUITE 140
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-951-7525
Practice Address - Fax:303-768-8450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINE ONE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB4968Medicare UPIN