Healthcare Provider Details

I. General information

NPI: 1386821742
Provider Name (Legal Business Name): COLORADO INSTITUTE OF DEVELOPMENTAL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 S SPRUCE ST SUITE 102
CENTENNIAL CO
80112-1283
US

IV. Provider business mailing address

6767 S SPRUCE ST SUITE 102
CENTENNIAL CO
80112-1283
US

V. Phone/Fax

Practice location:
  • Phone: 303-563-8290
  • Fax:
Mailing address:
  • Phone: 303-563-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number1544516
License Number StateCO

VIII. Authorized Official

Name: LAURA B JOHNSON
Title or Position: BILLING & FINANCE DIRECTOR
Credential:
Phone: 303-563-8290