Healthcare Provider Details

I. General information

NPI: 1528157526
Provider Name (Legal Business Name): ASPEN LEAF SPORTS MEDICINE AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 EARLE CIR
BOULDER CO
80301-4122
US

IV. Provider business mailing address

4861 EARLE CIR
BOULDER CO
80301-4122
US

V. Phone/Fax

Practice location:
  • Phone: 303-349-5269
  • Fax: 720-479-8320
Mailing address:
  • Phone: 303-349-5269
  • Fax: 720-479-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MINDY GEHRS
Title or Position: OWNER
Credential:
Phone: 303-349-5269