Healthcare Provider Details

I. General information

NPI: 1801077359
Provider Name (Legal Business Name): MAUREEN RIMAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 LAUREL AVE
BOULDER CO
80303-2842
US

IV. Provider business mailing address

842 LAUREL AVE
BOULDER CO
80303-2842
US

V. Phone/Fax

Practice location:
  • Phone: 303-402-9088
  • Fax: 303-402-9092
Mailing address:
  • Phone: 303-402-9088
  • Fax: 303-402-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2300
License Number StateCO

VII. Legacy identifiers

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

# 1
IdentifierC24593
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerMEDICARE ID NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: