Healthcare Provider Details

I. General information

NPI: 1548709728
Provider Name (Legal Business Name): INTEGRATIVE HEALTH AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 HARLAN ST SUITE 510
DENVER CO
80212-7415
US

IV. Provider business mailing address

4704 HARLAN ST SUITE 510
DENVER CO
80212-7415
US

V. Phone/Fax

Practice location:
  • Phone: 303-424-7171
  • Fax: 303-421-0705
Mailing address:
  • Phone: 303-463-0722
  • Fax: 303-421-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMARA JOHNSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 303-463-0722