Healthcare Provider Details

I. General information

NPI: 1477120343
Provider Name (Legal Business Name): RACHEL GANGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
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: 303-840-7325
  • Fax:
Mailing address:
  • Phone: 720-324-9380
  • Fax: 303-221-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0017134
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: