Healthcare Provider Details

I. General information

NPI: 1871219865
Provider Name (Legal Business Name): REPATTERN THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E 17TH AVE STE 1
DENVER CO
80206-1813
US

IV. Provider business mailing address

3500 E 17TH AVE STE 1
DENVER CO
80206-1813
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-7684
  • Fax:
Mailing address:
  • Phone: 720-515-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MERIDITH ANTONUCCI
Title or Position: OWNER
Credential:
Phone: 720-515-7684