Healthcare Provider Details

I. General information

NPI: 1154250389
Provider Name (Legal Business Name): TANNER BODINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHEELING ST
AURORA CO
80045-7211
US

IV. Provider business mailing address

955 QUENTIN ST
AURORA CO
80011-6309
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13818885-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: