Provider Demographics
NPI:1669695029
Name:SPORTS AND ORTHOPEDIC REHABILITATION, PLLC
Entity type:Organization
Organization Name:SPORTS AND ORTHOPEDIC REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEMLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-238-4277
Mailing Address - Street 1:2801 YOUNGFIELD ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2263
Mailing Address - Country:US
Mailing Address - Phone:303-238-4277
Mailing Address - Fax:303-238-4977
Practice Address - Street 1:2801 YOUNGFIELD ST
Practice Address - Street 2:SUITE 150
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2263
Practice Address - Country:US
Practice Address - Phone:303-238-4277
Practice Address - Fax:303-238-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO206022084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC805012OtherMEDICARE ID - UNSPECIFIED
COC805012OtherMEDICARE ID - UNSPECIFIED
COC805011Medicare PIN