Healthcare Provider Details

I. General information

NPI: 1053274936
Provider Name (Legal Business Name): ROBERT PENHOLLOW DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 S PERRY ST STE D
CASTLE ROCK CO
80104-1942
US

IV. Provider business mailing address

814 S PERRY ST STE D
CASTLE ROCK CO
80104-1942
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-2865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020992
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: