Provider Demographics
NPI:1336622570
Name:BOULDER NEUROLOGY AND CONCUSSION PLLC
Entity Type:Organization
Organization Name:BOULDER NEUROLOGY AND CONCUSSION PLLC
Other - Org Name:BOULDER NEUROLOGY AND CONCUSSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-738-8738
Mailing Address - Street 1:275 CENTURY CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9729
Mailing Address - Country:US
Mailing Address - Phone:720-738-8738
Mailing Address - Fax:720-862-2184
Practice Address - Street 1:275 CENTURY CIR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9729
Practice Address - Country:US
Practice Address - Phone:720-738-8738
Practice Address - Fax:720-862-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty