Healthcare Provider Details

I. General information

NPI: 1265980569
Provider Name (Legal Business Name): ORTHOMOTION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PINE ST SUITE 113
BOULDER CO
80302-4809
US

IV. Provider business mailing address

1240 PINE ST SUITE 113
BOULDER CO
80302-4809
US

V. Phone/Fax

Practice location:
  • Phone: 305-505-5596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOT0003373
License Number StateCO

VIII. Authorized Official

Name: LORENA BUTRON
Title or Position: MANAGING DIRECTOR
Credential: OTRL
Phone: 305-505-5596