Provider Demographics
NPI:1538197678
Name:COLORADO PAIN & REHABILITATION PLLC
Entity type:Organization
Organization Name:COLORADO PAIN & REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
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 1:4835 W 10TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2047
Mailing Address - Country:US
Mailing Address - Phone:970-356-4066
Mailing Address - Fax:
Practice Address - Street 1:4835 W 10TH ST
Practice Address - Street 2:STE B
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2047
Practice Address - Country:US
Practice Address - Phone:970-356-4066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18859020Medicaid