Healthcare Provider Details

I. General information

NPI: 1255801270
Provider Name (Legal Business Name): ERIC MOBERLY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6235 S MAIN ST STE 101
AURORA CO
80016-5373
US

IV. Provider business mailing address

6235 S MAIN ST STE 101
AURORA CO
80016-5373
US

V. Phone/Fax

Practice location:
  • Phone: 303-785-7928
  • Fax:
Mailing address:
  • Phone: 303-785-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0015998
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: