Healthcare Provider Details

I. General information

NPI: 1346901097
Provider Name (Legal Business Name): KEITH ROEHL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12229 VOYAGER PKWY STE 150
COLORADO SPRINGS CO
80921-3790
US

IV. Provider business mailing address

6855 DONNELAITH PL
COLORADO SPRINGS CO
80922-3110
US

V. Phone/Fax

Practice location:
  • Phone: 719-488-0120
  • Fax: 719-471-4415
Mailing address:
  • Phone: 320-266-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0019523
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: