Provider Demographics
NPI:1316486624
Name:SOUTHERN COLORADO PHYSICAL MEDICINE
Entity type:Organization
Organization Name:SOUTHERN COLORADO PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRET
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-842-0367
Mailing Address - Street 1:155 PRINTERS PKWY STE 200
Mailing Address - Street 2:#200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-6102
Mailing Address - Country:US
Mailing Address - Phone:719-632-4754
Mailing Address - Fax:
Practice Address - Street 1:400 INDIANA ST
Practice Address - Street 2:SUITE 320
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5027
Practice Address - Country:US
Practice Address - Phone:303-842-0367
Practice Address - Fax:888-382-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty