Provider Demographics
NPI:1427139054
Name:COLORADO PAIN AND REHAB PROFESSIONAL LLC
Entity type:Organization
Organization Name:COLORADO PAIN AND REHAB PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-423-8334
Mailing Address - Street 1:2490 W 26TH AVE
Mailing Address - Street 2:SUITE A120
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5314
Mailing Address - Country:US
Mailing Address - Phone:303-433-2300
Mailing Address - Fax:303-561-4369
Practice Address - Street 1:2490 W 26TH AVE
Practice Address - Street 2:SUITE A120
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5314
Practice Address - Country:US
Practice Address - Phone:303-433-2300
Practice Address - Fax:303-561-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000000000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty