Healthcare Provider Details

I. General information

NPI: 1114420114
Provider Name (Legal Business Name): RED ROCKS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 W COLORADO AVE
COLORADO SPRINGS CO
80904-1906
US

IV. Provider business mailing address

3208 W COLORADO AVE
COLORADO SPRINGS CO
80904-1906
US

V. Phone/Fax

Practice location:
  • Phone: 719-313-9466
  • Fax: 719-960-2095
Mailing address:
  • Phone: 719-313-9466
  • Fax: 719-960-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0012668
License Number StateCO

VIII. Authorized Official

Name: HEATHER BOEHLKE
Title or Position: OWNER
Credential: DPT
Phone: 719-313-9466