Healthcare Provider Details

I. General information

NPI: 1164023768
Provider Name (Legal Business Name): MITCHELL SCHROEDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 WALNUT ST STE 100
BOULDER CO
80302-5744
US

IV. Provider business mailing address

2505 WALNUT ST STE 100
BOULDER CO
80302-5744
US

V. Phone/Fax

Practice location:
  • Phone: 303-736-9343
  • Fax: 844-872-5595
Mailing address:
  • Phone: 303-736-9343
  • Fax: 844-872-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
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: MITCHELL SCHROEDER
Title or Position: OWNER
Credential:
Phone: 303-728-4177